Penile Fracture: Surgical Repair and Late Effects on Erectile Function

Abstract

Introduction Penile fracture is described as a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. Aim To assess the etiology, treatment maneuvers, and late effects of penile fractures treated by surgical repair. Methods Thirty-three patients diagnosed provisionally as having fractured penises. Thirty patients were managed by immediate surgical repair and three by delayed repair. Main Outcome Measures International Index of Erectile Function-5 for married cases and Single-question Self-report of Erectile Dysfunction questionnaires and recording complications after 2, 3, and 6 months. Results The most common cause of fracture penis is self-inflicted acute bending (54.5%). The tear was visualized by ultrasound in 20/30 patients (66.7%) mostly on the right proximal third of the penis. All tears were unilateral with mean length 2.0 ± 0.9 cm (range 0.5–4 cm). All patients who completed their follow-up after 6 months (N=24) were able to achieve an adequate erection except two married cases who felt mild erectile dysfunction. Penile nodules were the most common postoperative complication (41.7%) after 6 months' follow-up. Patients treated with immediate or delayed repair had comparable complications. Conclusions Fracture penis is not uncommon as an emergency that must be repaired either immediately or delayed. Clinical diagnosis is more predictive than ultrasound in diagnosis and determining the site of the tear. Ultrasound may be of value in patients where there is clinical doubt.

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

“…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.…”

“…26 The right side was commonly affected (56.1%) in agreement with many reports. 6,15 An explanation to this was proposed by Ateyah et al 15 by the fact that most patients are right-handed where they manipulate the penis to the left side that may result in right-sided tears. False fracture was diagnosed in 8.8%, which is in harmony to the 4-10% range reported in the literature.…”

“…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?…”

Sexual function outcomes following fracture of the penis.

“…2 Many recently reports have come from Middle Eastern countries where the fractures are usually caused by "taqaandan" or forcefully bending the erect penis to achieve detumescence. 3,4 Penile fracture has a typical clinical presentation. Patients report hearing a snapping sound during the sexual act, followed by immediate pain and penile detumescence, in addition to the emergence of large edema, hematoma and penile deformity.…”

Fracture penis with urethral disruption & scrotal hematoma: A case report

“…4 Sporadic reports of penile fracture give the impression of a rare trauma but penile fracture is not so rare. 5 The true incidence of penile fracture is not known even in western countries because it is under reported or hidden probably because of social embrassement and sociocultural characteristics, even it is reported to physicians it remains undiagnosed or mismanaged.…”