Epidemiology of Penile Fractures in United States Emergency Departments: Access to Care Disparities May Lead to Suboptimal Outcomes

Abstract

Introduction The epidemiology of penile fractures in the emergency setting is not well described. Aim Examine the incidence, evaluation, management, risk factors predicting surgical repair or hospital transfer, and use of financial resources in patients presenting with penile fractures to the emergency departments (ED) nationwide in the Unites States. Methods ED visits with a primary diagnosis of penile fractures (International Classification of Diseases, Ninth Edition codes) between 2010-2014 were abstracted from the Nationwide Emergency Department Sample. Main Outcome Measure Penile fracture incidence, disposition, hospital, and clinical factors which were associated with immediate surgical repair or transfer to another institution, and cost were investigated. Results 8,029 ED visits for penile fracture in the United States were observed, which represents a national incidence of 1.02 per 100,000 male subjects per year. No meaningful trends in incidence were observed over the 5-year period. 63.9% were treated non-surgically or discharged from the ED, 25.7% underwent surgical repair, and 10.3% were transferred to other institutions. Hospital factors which predicted surgical repair included Northeast region, teaching hospital status, trauma hospital status, high volume ED, and urban location. Clinical risk factors which predicted surgical repair included hypertension, smoking, alcohol dependence, drug abuse, erectile dysfunction, hematuria, urethral injury, and urinary retention. Factors leading to patient transfers included non-academic, rural and non-trauma hospitals, low economic income and low emergency department volume. In addition, weekend and spring presentation were associated with higher transfer rates, while summer presentation was associated with surgical repair. Clinical Implications A large proportion of penile fractures are discharged from the ED, indicating possible health care access disparity. Strengths & Limitations This is one of the first population-based study of penile fracture incidence, disposition, risk factors which predict surgery or transfer, and cost in the US ED setting. The unexpected high number of discharges may be a result of misdiagnosis; alternatively these data may reveal previously under-reported management patterns in the community. Conclusion This large retrospective study of penile fractures in the US ED setting demonstrates a stable incidence of penile fractures presenting to the US emergency departments. A quarter of patients undergo immediate surgical repair, 10% are transferred to other institutions and 63.9% of patients are discharged home. The high proportion of ED discharges may be due to access to health care disparities.

Risk factors for penile fracture compared with a surgical control cohort in the United States

“…In a study evaluating over 8000 emergency room visits for suspected PF, drug and alcohol abuse were more common in the patients admitted for surgical repair. 12 While not evaluating PF per se , other studies have evaluated the behavior associated with substance abuse that promotes penile injury that ultimately leads to surgical intervention. 14 In a post hoc analysis, we found no association with substance abuse and more severe injuries ( i.e.…”

“…This finding was corroborated by Rodriguez et al . 12 in a series of emergency room patients. While initially counterintuitive, it is possible that patients with erectile dysfunction are likely to develop an injury during vigorous intercourse with a suboptimal erection.…”

“…In the aforementioned study of over 8000 US patients presenting to the emergency department with a diagnosis of PF, nearly two-third of the patients were discharged and only a quarter underwent surgical repair. 12 However, the majority of truly clinically suspicious PF will undergo exploration, and therefore it is likely that our sample captured the majority of patients. Second, the administrative nature of the NIS does not allow us to determine the sequence of diagnoses ( i.e.…”

“…In the last few years, several investigators have published series on PF that are country specific, treatment focused for a small cohort, or focused on emergency department settings. 10 11 12 These are largely retrospective analyses that do not contextualize PF with respect to other surgical emergencies. To address this gap in knowledge, we sought to characterize the temporal and demographic variations in the incidence, diagnostic evaluation, and surgical management of patients with penile fracture by performing a comparison to a control cohort of male patients admitted for appendectomy, a disease that indiscriminately affects the general population.…”

Fracture of the penis in Jos, Nigeria: review of cases in 2020

“…In Nigeria, the incidence cannot be readily ascertained due to the dearth of information. 5,6 coital position (usually the penis slips out of the vagina and hits the pubic bone during thrust) or anal intercourse or masturbation. Other mechanical trauma that results in forceful bending of an erect penis may also lead to penile fracture.…”