general anesthesia may be required to expose and remove the hair A high degree of suspicion should be maintained as complications include urethrocutaneous fistula or loss of the penis Fracture of the penis is produced by traumatic rupture of the corpus cavernosum This injury usually occurs when the erect penis is forced against a hard surface, most commonly during sexual activity The patient may hear a cracking sound and develop pain, edema, and deformity of the penis shaft with abrupt loss of erection An “eggplant deformity” of the penis is often present The urethra may be involved in 3% to 32% of injuries, especially in those with more extensive or bilateral corporal injuries Penile fractures require surgical treatment with evacuation of the penile hematoma, repair of the torn tunica albuginea, urethral repair if necessary and a pressure dressing Superficial lacerations of the penile shaft can be repaired with absorbable sutures under local anesthesia or penile block Lacerations extending to the corporal bodies or the urethra require urologic consultation due to the depth of injury and significant bleeding Injuries to the corporal bodies should be repaired primarily to prevent fibrosis and impotence If concomitant urethral injury is suspected, diagnostic evaluation includes a RUG to define the extent of the injury Injuries to the urethra may require primary repair and/or temporary urinary diversion Zipper entrapment of the penis or foreskin is a common complaint that can be managed in the ED Methods of emergent release have been described in relation to the zipper parts and depending on the type of zipper The median bar of the zipper may be cut with wire cutters and thus disassembling the zipper mechanism ( Fig 108.6 ) This technique may sometimes prove difficult when the metal bar is sturdy and there is edema of the entrapped penile tissue within the zipper fastener, limiting access to the metal bar Such may be the case with heavy metal zippers such as those found on jeans and dungarees, and success may depend on the strength of the operator and the availability of bone or wire cutters Therefore, this technique may work best with plastic or lightweight zippers Cutting the dentition of the zipper at any position, permitting unzipping of the zipper from the rear may work best for heavy-duty metal zippers Disengagement of the fastener by inserting a flathead screwdriver between the inner and outer faceplates and applying torque toward the median bar ( Fig 108.7 ) may prove helpful when it is difficult to grasp the tiny median bar with bulky cutting pliers Elliptical incision of the entrapped foreskin or emergency circumcision can be of value when less invasive methods have failed Regardless of technique, procedural sedation may facilitate the procedure Edema can be treated with warm soaks