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Keskin ET, Can O, Filtekin YC, Özdemir H, Şahin M, Çeker G, Topal C, Canat HL. Comparison of erectile and ejaculatory functional outcomes between unilateral and bilateral cavernosal rupture in penile fractures. Int J Impot Res 2024; 36:659-664. [PMID: 38918564 PMCID: PMC11377296 DOI: 10.1038/s41443-024-00940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
This study aimed to compare the erectile and ejaculatory functional outcomes of unilateral and bilateral ruptures of the corpus cavernosum in penile fractures. Sixty patients' data were analyzed retrospectively between June 2020 and January 2023. The patients were divided into two groups based on the affected corpus cavernosum (unilateral and bilateral). Preoperative and postoperative 3rd-, 6th-, and 12th-month self-estimated intravaginal-ejaculation-latency-time (IELT), and international index of erectile function-erectile function (IIEF-EF) scores as well as the presence of urethral injury were compared. Bilateral corpus cavernosum fractures were detected in 18.3% of the patients. The IIEF-EF scores of both groups at 3rd-, 6th-, and 12th-month were found to be significantly lower than the preoperative scores (unilateral group:24.1 ± 2.7 vs 23.2 ± 3.5 and 23.3 ± 3.4, respectively, p = 0.011 and 0.014, respectively; bilateral group: 24 ± 1.9 vs 23 ± 1.8 and 23.2 ± 1.5, respectively, p = 0.027 and 0.047, respectively). No significant difference was found between the preoperative and the postoperative 12th month IIEF-EF scores in either group (unilateral group: 24.1 ± 2.7 vs 23.4 ± 3.6, p = 0.207;bilateral group:24 ± 1.9 vs 23.2 ± 1.5, p = 0.057). The self-estimated IELTs of both groups at the postoperative 3rd, 6th, and 12th months demonstrated a significant increase from the preoperative values (unilateral group: 221.6 ± 81.8 vs 252 ± 94.6, 256.5 ± 97.6, and 250.5 ± 104.8, respectively, p < 0.001; bilateral group:241.8 ± 61.6 vs 278.1 ± 55.4, 281.8 ± 56.1, and 283.6 ± 54.2, respectively, p = 0.041, 0.030, and 0.047, respectively). The changes in self-estimated IELTs and IIEF-EF scores between the preoperative period and the postoperative 3rd, 6th, and 12th-months were compared, and no statistical difference was found between patients with unilateral and bilateral corpus cavernosum fractures (p > 0.05). In conclusion, no significant difference in erectile function was found in either group at the 12-month follow-up, and the self-estimated IELTs were found to be prolonged in both groups. Furthermore, no difference was noted between the groups at any follow-up. To explain the effects of unilateral and bilateral injuries on erectile and ejaculatory functions, further studies with a larger-number of patients are necessary.
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Affiliation(s)
- Emin Taha Keskin
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Osman Can
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Yiğit Can Filtekin
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Harun Özdemir
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Şahin
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Gökhan Çeker
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Cemal Topal
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Halil Lütfi Canat
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Maremanda AP, Du Comb W, Able C, Kohn TP, Unal S, Burnett AL. Erectile dysfunction and Peyronie's disease diagnosis rates after penile fracture-a retrospective claims database cohort analysis. Int J Impot Res 2024; 36:125-128. [PMID: 37542153 DOI: 10.1038/s41443-023-00746-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Our objective was to analyze the rates of erectile dysfunction and Peyronie's disease following a penile fracture using a large, multi-institutional claims database. Inclusion criteria included men ages 15 or older with a diagnosis of penile fracture and any office visit within 5 years of the penile fracture. Exclusion criteria included prior erectile dysfunction, prescription of erectile aids, or penile prosthesis placement. Our primary outcome was the diagnosis of erectile dysfunction or prescription of phosphodiesterase-5 inhibitors within 5 years. A secondary analysis assessed rates of Peyronie's disease following penile fracture. 1242 men were identified with penile fracture and subsequently matched to men without penile fracture, resulting in equal cohorts of 1227 men. Men with a history of penile fracture were more likely to receive a diagnosis of erectile dysfunction or require phosphodiesterase-5 inhibitors (RR 3.18, 95% CI: 2.30-4.40). Men who did not undergo immediate repair had higher rates of erectile dysfunction or treatment (RR: 1.84, 95% CI: 1.22-2.78). Men over the age of 45 years who had a penile fracture were more likely to develop erectile dysfunction or treatment compared to men under 45 years (RR: 1.65, 95% CI: 1.14-2.39). Rates of Peyronie's disease were higher in men with a history of penile fracture (5.8% vs 0%, p < 0.0001). Rates of Peyronie's disease were lower if immediate repair of the fracture was performed (RR: 0.20, 95% CI: 0.10-0.41). Men over the age of 45 years with penile fracture were more likely to develop Peyronie's Disease within 5 years compared to men under the age of 45 years penile fracture (RR: 3.72, 95% CI: 1.94-7.16). Penile fracture increases the risk of both erectile dysfunction and Peyronie's disease, especially those treated with conservative measures or over the age of 45 years compared to patients under 45 years with a penile fracture.
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Affiliation(s)
| | - William Du Comb
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corey Able
- University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Selman Unal
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hardesty J, Burns RT, Soyster ME, Mellon M, Bernie HL. A review of the literature and proposed algorithm for penile fracture management. Sex Med Rev 2023; 12:100-105. [PMID: 37786337 DOI: 10.1093/sxmrev/qead041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION In the management of penile fractures, immediate surgical repair has resulted in better outcomes when compared with a conservative approach; however, there is currently no consensus on the treatment of patients presenting beyond the immediate period (>24 hours) following injury. OBJECTIVES To examine the latest literature on management strategies in penile fracture and propose an optimal algorithm for the treatment of patients with delayed presentation. METHODS A comprehensive search was conducted following the PRISMA-P 2020 guidelines. A search was performed in several databases with the following strategy: ("Penile fracture" OR "fracture of penis" OR "rupture of corpora cavernosa" OR "rupture of tunica albuginea") AND (management OR treatment OR surgery OR "surgical reconstruction" OR "surgical repair"). This resulted in 108 relevant articles. Two independent reviewers screened these articles according to the inclusion criteria. Full-text review of 56 articles was performed, and ultimately 20 studies were selected. Measures included the use of diagnostic imaging, timing of surgical repair (immediate, <24 hours after injury; delayed, >24 hours), surgical approach, and long-term complications (ie, erectile dysfunction and penile curvature). RESULTS The review highlighted the benefits of immediate surgical repair in penile fractures, demonstrating improved patient outcomes. Furthermore, it found that surgical repair should be considered even in cases with delayed presentation (>24 hours after injury). To better evaluate the long-term impact of delayed surgical intervention on patient outcomes, we recommend standardized postoperative follow-up, with routine assessments of erectile function and penile curvature. CONCLUSION Contemporary literature suggests that immediate and delayed surgical repair of penile fractures leads to adequate postoperative outcomes, and patients presenting >24 hours after injury should still be considered for surgery.
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Affiliation(s)
- Juliet Hardesty
- School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Ramzy T Burns
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Mary E Soyster
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Matthew Mellon
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
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GamalEl Din SF, Nabil N, Ragab MW, Saad H, Labib M, Abo Sief A. Role of penile rehabilitation through daily intake of 5 mg tadalafil on erectile dysfunction after different presentations of penile fracture: a prospective case-control study. Int Urol Nephrol 2023; 55:2781-2787. [PMID: 37526789 PMCID: PMC10560249 DOI: 10.1007/s11255-023-03713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE We aimed in the current study to identify the predictive factors of ED occurrence in healthy individuals following penile fracture surgical repair as well as the effect of penile rehabilitation in the form of daily tadalafil 5 mg intake for 1 month for patients who suffered from ED after penile fracture incident. METHOD The current study was a prospective case-control study. Twenty-five patients were enrolled into the study starting from January (2022) to February (2023). Furthermore, time of presentation was determined, and length of tear intra-operative was measured, and then, a follow-up 1 week postoperatively in the outpatient clinic was conducted. All patients were instructed to start intercourse at least 2 weeks after the first visit provided that the wound epithelialized. Potent patients returned back home. A rehabilitation course of daily tadalafil 5 mg for 1 month was prescribed for patients who started complaining of ED that was confirmed by evaluation with the Arabic validated version of the international index of erectile function (ArIIEF-5). The rehabilitation therapy was terminated by resumption of normal erectile function. Thus, re-evaluation with the ArIIEF-5 was determined according to their response to therapy. Also, the patients were evaluated by hospital anxiety and depression scale (HADS) before and after penile fracture repair. RESULTS The current study had demonstrated that a 1% increase in age determines an increase in odds ratio for post-penile fracture ED with 73.6% and 1 cm increase in the length of tear determines an increase in odds ratio for post-penile fracture ED with 20.04 times. CONCLUSION The current study enhances the proper counseling of these patients prior to repairing the defect about the probability of ED occurrence as well as initiating early penile rehabilitation to help these patients resuming their normal sexual activity as soon as possible.
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Affiliation(s)
- Sameh Fayek GamalEl Din
- Andrology and STDs Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Nashaat Nabil
- Andrology and STDs Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Mohamed Wael Ragab
- Andrology and STDs Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Saad
- Department of Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mariam Labib
- Egypt Ministry of Health and Population, Cairo, Egypt
| | - Ahmed Abo Sief
- Andrology and STDs Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
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Imran M, Kamran A, Tanveer A, Farho MA. Penile fracture: A case report. Int J Surg Case Rep 2023; 110:108749. [PMID: 37666155 PMCID: PMC10509845 DOI: 10.1016/j.ijscr.2023.108749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Penile fracture, resulting from trauma to an erect penis, is a rare urogenital injury with potentially serious complications including erectile dysfunction. This case report emphasizes the significance of prompt recognition, accurate diagnosis, and timely surgical management to optimize patient outcomes. CASE PRESENTATION The case involves a 34-year-old male presenting with acute pain, swelling, and a visibly deformed penis following sexual intercourse. Clinical examination confirmed the diagnosis of penile fracture, leading to surgical repair of the tunica albuginea. The patient had an uneventful post-operative recovery and received appropriate post-operative instructions. CLINICAL DISCUSSION A penile fracture is a rare but serious injury occurs due to a tear in the tunica albuginea that can occur during vigorous sexual activity causing sudden pain, swelling, and produce a popping sound. Classical presentation often leads to establish a clinical diagnosis. However, immediate surgical exploration and repair is needed for better outcomes and to prevent long term complications such as erectile dysfunction or curvature of the penis that are associated with relying solely on conservative management. Delayed presentation also affects the optimal outcomes of surgery. CONCLUSION This report highlights the importance of early surgical intervention, the impact of delayed presentation, and the need for increased awareness regarding penile fractures. This case adds to the existing surgical literature by providing insights into the clinical presentation and management of penile fractures. The comprehensive overview of the case contributes to a better understanding of penile fractures and their management, helping healthcare professionals, improves patient care and outcomes.
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Affiliation(s)
- Muhammad Imran
- University College of Medicine and Dentistry, University of Lahore, Lahore, Pakistan
| | - Ateeba Kamran
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Aiman Tanveer
- University College of Medicine and Dentistry, University of Lahore, Lahore, Pakistan
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Avci IE, Yilmaz H, Cinar NB, Akdas EM, Teke K, Culha MM. Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes. Sex Med 2023; 11:qfad048. [PMID: 37663046 PMCID: PMC10468742 DOI: 10.1093/sexmed/qfad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture. Aim To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures. Methods Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes. Outcomes Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair. Results Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4 years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037). Clinical Implications Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period. Strengths and Limitations The study's retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function. Conclusion These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.
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Affiliation(s)
- Ibrahim Erkut Avci
- Department of Urology, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Hasan Yilmaz
- Department of Urology, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Naci Burak Cinar
- Department of Urology, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Enes Malik Akdas
- Department of Urology, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Kerem Teke
- Department of Urology, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Mustafa Melih Culha
- Department of Urology, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
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Long term complications of penile fracture repair: Erectile dysfunction and penile curvature. Rev Int Androl 2022; 20:116-120. [PMID: 35339402 DOI: 10.1016/j.androl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/27/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the factors that cause erectile dysfunction and penile curvature after repair of penile fracture (PF). METHODS Data from 25 patients who underwent PF repair was retrospectively analyzed. PF was diagnosed by examining patients' medical histories and performing physical examinations. All patients underwent immediate PF repair. All patients filled out the International Index of Erectile Function (IIEF-5) form and penile curvature was examined. RESULTS The median age of patients at the time of surgery and the median follow-up duration were 46 years (22-60 years) and 95 months (12-156 months), respectively. Two of the patients had concomitant urethral injury. At the final follow up, erectile dysfunction (ED) was present in 13 patients (52%). Among these patients, 9 patients (36%) had mild ED and 4 patients (16%) had moderate ED. With a univariate analysis, age and penile curvature were significantly associated with ED (p=0.008 and p=0.039, respectively). With a multivariate analysis, age was independently associated with ED (p=0.048, odds ratio=1.104, 95% confidence interval 1.000-1.218). The IIEF-5 scores correlated with age (p=0.009, r=0.510). Seven patients (28%) had penile curvature and one patient underwent penile plication surgery. CONCLUSION After PF repair, age is the only risk factor for ED and penile curvature rarely requires surgical treatment.
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Bulbul E, Gultekin MH, Citgez S, Derekoylu E, Demirbilek M, Akkus E, Ozkara H. Penile fracture: Tertiary care center experience and long-term complications after immediate repair. Andrology 2021; 10:560-566. [PMID: 34939748 DOI: 10.1111/andr.13148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the literature, there is not sufficient data on factors affecting the development of complications in patients with penile fracture after early surgical intervention. OBJECTIVES To investigate the predictors of long-term complications in patients who underwent immediate surgical repair for penile fracture. MATERIALS/METHODS This clinical study included a total of 31 cases of penile fracture in which surgical treatment was performed within the first 24 hours and penile fracture was confirmed during the operation. The patients with and without late complications were compared in terms of parameters such as age, tear size of the tunica albuginea of the penis, bilateral involvement of the corpora cavernosa involvement, urethral injuries, and duration from penile fracture to surgery. RESULTS The median age of the patients was 42 (interquartile range [IQR]: 34-51) years. The median time from penile fracture to surgery was 13 (8-18) hours. The median tear size was 16 (11-21) mm. Late complications were seen in 13 (41.9%) patients in the postoperative period. Erectile dysfunction (ED) developed in five (16.1%) patients in the postoperative period. There was no statistically significant relationship between age, tear size, time from penile fracture to surgery, and bilateral corporeal involvement in terms of ED development. Painful erections, penile deviations, urethral strictures, tunical scars, and re-fracture were the other late complications. There was a significant relationship between the development of any complication and time from penile fracture to surgery (p = 0.028) and tear size (p = 0.031). In the receiver operating characteristic analysis of complication development, the cut-off value for the time from penile fracture to surgery was 13.5 hours. DISCUSSION AND CONCLUSION We found that the longer time interval between penile fracture and surgery worsened the patient outcomes. In addition, tear size was determined to be a predictor for long-term complications. In our opinion, early treatment of penile fracture can prevent severe complications in these cases. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Emre Bulbul
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Mehmet Hamza Gultekin
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Sinharib Citgez
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Engin Derekoylu
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Muhammet Demirbilek
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Emre Akkus
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Hamdi Ozkara
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
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Yavuzsan AH, Albayrak AT, Yesildal C, Ilgi M, Baloglu IH, Eksi M, Horasanli K, Kirecci SL, Ozkurt H. The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes. Int J Clin Pract 2021; 75:e14568. [PMID: 34165862 DOI: 10.1111/ijcp.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes. METHODS Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value. RESULTS The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%). CONCLUSIONS US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.
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Affiliation(s)
- Abdullah Hizir Yavuzsan
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Yesildal
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Musab Ilgi
- Department of Urology, KMG Klinikum Luckenwalde, Luckenwalde, Germany
| | - Ibrahim Halil Baloglu
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mithat Eksi
- Department of Urology, Arnavutkoy State Hospital, Istanbul, Turkey
| | - Kaya Horasanli
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sinan Levent Kirecci
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Ozkurt
- Department of Radiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Sharma KL, Bole R, Yang D, Alom M, Savage J, Ziegelmann M, Trost L. Conservative management of suspected fractures in men undergoing collagenase clostridium histolyticum for Peyronie's Disease is not associated with worsening of erectile function. Int J Impot Res 2020; 34:100-107. [PMID: 33318638 DOI: 10.1038/s41443-020-00383-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022]
Abstract
The optimal management of suspected penile fractures post collagenase clostridium histolyticum (CCH) remains indeterminate, with some advocating for observation and others surgical repair. To address this issue, the current study sent surveys to 158 men with Peyronie's Disease (PD) who completed four CCH injection series. The survey included the Erectile Function Domain from the International Index of Erectile Function (IIEF-EFD) and questions regarding potential symptoms of corporal rupture (hematoma, popping, and detumescence). Men were categorized as having a suspected fracture (SF+) if they reported a popping sensation or rapid detumescence. All SF(+) men were managed conservatively without surgical intervention. Results were compared statistically against baseline IIEF-EFD values and between SF(+) and SF(-) groups. The key study objective was to determine whether erectile function was negatively impacted by conservative management of suspected fractures. Of the 53 returned surveys, 45 had complete data for review. The sample was statistically representative of the broader cohort of 158 men, except being older (60.0 vs 57.1 [SD 6.0 vs 9.0], p = 0.01) with shorter durations of PD (median 9 [IQR 5, 19] mo vs 13 [IQR 8, 24], p = 0.01). Overall, 7/45 (16%) of men were defined as SF(+), with all fractures occurring within 6 weeks of CCH administration. No demographic or pathophysiologic characteristics predicted SF(+). Importantly, SF(+) men did not experience worsened erectile function compared to SF(-), with a median IIEF-EFD change of +2 vs +1, p = 0.16, respectively. Curvatures were improved to a greater degree among SF(+) men (primary: median -30 [IQR -20, -32.5] vs -15 [-5, -26], p = 0.04; composite: -35 [-25, -40] vs -25 [-7, -30], p = 0.15). We concluded that suspected penile fractures in PD men undergoing CCH may be reasonably managed without surgical intervention and portend greater improvements in curvature correction.
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Affiliation(s)
| | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - David Yang
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Manaf Alom
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA. .,Male Fertility and Peyronie's Clinic, Orem, UT, USA.
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