# Perineal Incision for the Surgical Management of Extremely Proximal Internal Penile Fractures—A Case Series and Review of Literature

## TL;DR

This paper describes four rare cases of penile fractures near the base, diagnosed with MRI and treated with a perineal surgical approach.

## Contribution

The study introduces a perineal surgical approach for managing extremely proximal internal penile fractures.

## Key findings

- MRI confirmed fractures at the penile base in patients with atypical symptoms.
- A midline perineal incision enabled successful surgical repair with no long-term complications.
- Perineal bruising and scrotal signs were prominent in these atypical cases.

## Abstract

This case series presents four cases of extreme proximal internal corpus cavernosum (EPICC) penile fractures. Patients, aged 33–53, presented with penile trauma primarily during sexual intercourse, exhibiting atypical symptoms sparing the penis but with significant perineal and scrotal bruising. Diagnosis was confirmed via penile magnetic resonance imaging (MRI), revealing fractures at the penile base. All patients underwent surgical repair through a midline perineal incision, with no long-term complications reported. This series highlights the value of MRI for diagnosing atypical fractures and supports a perineal surgical approach for optimal exposure and repair in EPICC fractures.