February 2026

UROLOGY

VENTRAL MIDLINE APPROACH TO PENILE FRACTURE WITH BILATERAL CORPORAL INJURIES AND COMPLETE URETHRAL AVULSION

Penile fracture with bilateral corporal rupture and complete urethral avulsion represents one of the most complex and rare urologic trauma scenarios. Traditional management relies on a subcoronal circumcising incision with full penile degloving, an approach that may complicate foreskin preservation and increase wound morbidity, particularly in uncircumcised patients.
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In a case report published in The Canadian Journal of Urology, a Northwestern Medicine team, led by Ziho Lee, MD, presents a compelling alternative: a ventral midline surgical approach that enabled successful repair of bilateral corporal injuries and complete urethral avulsion while preserving the foreskin, with excellent long-term functional outcomes.
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Overview
  • 29‑year‑old uncircumcised male presented within two hours of injury with penile pain, detumescence, blood at the meatus and urinary retention.
  • RUG and cystoscopy demonstrated circumferential mid‑penile urethral avulsion.
  • Surgical approach: Ventral midline penile incision chosen to allow direct exposure and preserve foreskin.

Intraoperative findings:
  • Bilateral corporal cavernosa injuries
  • Complete urethral transection with about a 3 centimeter gap

Repair:
  • Bilateral corporotomy closure with watertight confirmation
  • Excision and primary urethral anastomosis after proximal urethral mobilization

Follow‑up:
  • RUG at four weeks showed no extravasation
  • Surveillance cystoscopy at nine months showed no stricture
  • At 24 months, patient reported normal erectile function, no curvature and no urinary symptoms

​Key Takeaways
  • Ventral midline incision provides direct visualization of corporal and urethral injuries without circumferential degloving, facilitating simultaneous corporal repair and urethroplasty.
  • Foreskin preservation is achievable in selected uncircumcised patients.
  • This case is only the second reported case of this approach for bilateral corporal rupture with urethral avulsion and the first successfully preserving the foreskin.
  • Ventral midline access may be considered a practical alternative to circumcising incisions in complex penile trauma.
Ziho Lee, MD, Chief of Trauma and Reconstructive Urology and Assistant Professor of Urology at Northwestern Medicine

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