Penile Fracture: A Meta-Analysis

Abstract

Objectives: To review the causes and management of penile fracture and to compare between surgical and conservative management as well as immediate and delayed interventions in terms of overall and specific complications. Methods: A search of all reported literature was conducted for all articles reporting on the management and outcomes of penile fractures. Full texts of relevant articles were obtained and screened according to the inclusion criteria. Outcomes measures were numbers of patients receiving surgical or conservative management, aetiology of fracture, length of admission, complications as well as the specifics of diagnostic approaches and operative management. Data was collated and where possible meta-analysed using Revman software. Results: A total of 58 relevant studies involving 3,213 patients demonstrated that intercourse accounts for only 48% of cases with masturbation and forced flexion accounting for 39%. Meta-analysis shows that surgical intervention was associated with significantly fewer complications vs. conservative management (p < 0.000001). Surgical intervention results in significantly less erectile dysfunction (ED), curvature and painful erection than conservative management. There was no significant difference in the number of patients developing plaques/nodules (p = 0.94). Meta-analysis shows that overall early surgery is preferable to delayed surgery but that rates of ED are not significantly different. Discussion: Early surgical intervention is associated with significantly fewer complications than conservative management or delayed surgery. The combined outcome of rapid diagnosis by history and clinical examination and swift surgical intervention is key for reconstruction with minimal long-term complications.

An update of Penile Fractures: Long-term significance of the number of hours elapsed till surgical repair on long-term outcomes

“…PF is a urologic emergency which amends surgical repair of the tunica albuginea. [1,2] The classic presentation during the early phase consists of a snap or a cracking sound during rigid erection accompanied by pain, and detumescence followed by rapid swelling and ecchymosis. [3] The clinical presentation is usually enough for the establishment of a correct diagnosis with little need for radiologic evaluation.…”

“…[3] The clinical presentation is usually enough for the establishment of a correct diagnosis with little need for radiologic evaluation. [1,4] Imaging modalities such as urethroscopy, urethrography or magnetic resonance imaging (MRI) can be used in case of a suspect urethral injury, which has been diagnosed in 21% of PF cases in the United States. [5] Timing of the surgery is a topic of debate concerning immediate or delayed intervention.…”

Penile Fracture: 20 Years' Clinical Experience

“…Penil fraktüre eşlik eden üretra rüptürü Avrupa'da %14-28 iken, İran'da ise %0-2 saptanmıştır. 7,8 Çalışmamızda üretra rüptürü görülen (%3,5) 4 hastamızın sadece birinin etiyolojisinde travma mevcuttur. Bu hastanın korpus kavernozumdaki defekti tek taraflıdır.…”

“…Amer ve ark.nın meta-analizinde; üretral kanama %5,6, üretral yaralanma %6,1 olarak bildirilmiştir. 7 Makroskobik ve mikroskobik hematüri hastaların %50'sinde üretral yaralanmayı işaret etmektedir. 16 Bunun gibi durumlarda üretrografi çekilmesi birçok araştır-macı tarafından önerilir iken, gerekli durumlarda da operasyon sırasında fleksibl sistoskopi yapılabil-mektedir.…”

“…16 Bunun gibi durumlarda üretrografi çekilmesi birçok araştır-macı tarafından önerilir iken, gerekli durumlarda da operasyon sırasında fleksibl sistoskopi yapılabil-mektedir. 7 Yedi hastamızda üretral meada kan gö-rülmesi sebebiyle çekilen preoperatif retrograd üretrografide iki komplet, iki inkomplet üretra rüp-türü saptanmıştır. Bu gibi durumlarda üretrografi-nin operasyon planlamasına yardımcı olacağı düşünülmektedir.…”