Delayed Surgical Repair of Penile Fracture under Local Anesthesia

Abstract

Introduction Penile fracture is a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. Aim To assess the efficacy of a simple delayed surgical repair of penile fracture after a conservative treatment under local anesthesia in patients presented after 24 hours. Methods Twenty-four patients with penile fracture presented after 24 hours were subjected to history taking, clinical examination, urine analysis, and penile ultrasound. They underwent conservative treatment for 7–12 days, and then a surgical repair under local anesthesia was carried out. Main Outcome Measures A follow-up for 6 months for sexual activity and any associated complaints in addition to local examination. Results All cases were presented with unilateral single tear, and the main cause of penile fracture was sexual intercourse. No intraoperative or postoperative complications were encountered. They regained their sexual activity 4–6 weeks after the repair. One case developed a mild penile deviation that did not interfere with sexual relation after the 6-month follow-up. Conclusion Surgical repair of penile fracture after a conservative treatment is an effective method for patients with delayed presentation devoid of urethral involvement.

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

“…After 18 months of follow-up, this technique had no complications. In agreement with Naraynsingh et al, 28 Nasser and Mostafa 16 reported successful outcome with this approach in 24 patients followed up for 6 months. None of their patients had ED or plaque of fibrosis.…”

“…On long term, 6.6% of patients in our series had ED, which is within the range of 0-16.6% previously reported. [13][14][15][16][17][18][19] We preferred the sub-coronal circumferential incision because of the excellent exposure of the three corpora, which avoids accidental missing of a urethral injury or multiple injuries of the tunica. 26 The right side was commonly affected (56.1%) in agreement with many reports.…”

“…In our series, the erectile function of patients with delayed presentation (424 h) compares favorably to those presented immediately after trauma with no statistically significant difference, which is similar to previous reports. 28,16 Penile vascular abnormalities after penile trauma were investigated by some authors. 11,13,29 Penson et al 11 evaluated 19 patients with ED after blunt trauma to erect penis by dynamic infusion cavernosometry/cavernosography and CDU.…”

“…11,13 Contemporary series showed that the incidence of ED after surgical repair of fracture penis ranges from 0% up to 16.6%. 6,7,[13][14][15][16][17][18][19] Several important issues may be raised during discussing the development of ED after surgical repair of fracture penis. First, is delayed presentation after trauma a risk factor for ED?…”

Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center

“…With regard to identifying characteristics of patients with true vs. false fracture, we noted that in our cohort, patients with confirmed penile fracture were generally younger and presented to the emergency department much sooner than those with a false fracture. Time from injury to operating suite did not seem to affect clinical outcome in our cohort, which is consistent with current literature regarding immediate vs. delayed fracture repair (Naraynsingh et al, 2003;Nasser & Mostafa, 2008;Yapanoglu et al, 2009;Kozacioglu et al, 2011). In fact, 22% of patients presenting within a day of injury had complications vs. 14% of those presenting more than a day from injury.…”