Penile fracture: experience in 56 cases

An unusual presentation of penile fracture with complete transection of urethra: a case report

Penile fracture is one such urologic emergency that occurs when the penis is struck bluntly during sexual activity, and in less than 5-10% of cases, the concurrent urethral damage is evident, but complete transection is very rare. A 37-year-old male presented with a history of 'snap' sound and immediate detumescence of penis during intercourse, when he fell and hit the pubic bone of his partner. There was acute retention of urine, an attempt to pass a catheter failed and the patient underwent supra-pubic catheterization. On examination, there was classical 'eggplant deformity' of the penis with blood at the tip of the meatus. MRI showed a tunical tear on both sides at the penoscrotal junction with indistinct urethra and extensive hematoma in the proximal penile shaft. Surgical management was successfully done by anastomotic urethroplasty and cavernosal repair.

Penile fracture: a case series of 18 patients

Introduction

Penile fractures are a rare urological emergency. It is defined as 'rupture of the tunica albuginea of one or both corpora cavernosa. The corpus spongiosum and the urethra may also be involved in this process.' The tunica albuginea is stiff and significantly thinner during erection than in the flaccid state, which is when injury generally happens.

Method

This case series was completed between January 2018 and January 2023 at the Department of General Surgery. Eighteen patients suspected of having penile fractures participated in were included this study. All patients were thoroughly evaluated upon hospital admission to identify the diagnosis, length of time since the accident, the site of the fracture, the extent of the penile hematoma, occurrence of blood at the external meatus, presence of urine retention, and intraoperative outcomes.

Results

The patients were between the ages of 24 and 70, with a mean age of 37. The duration before the presentation ranged from 7 h to 1 month (the median was 22 h). Sexual intercourse was the cause in 12 (66%) cases, rolling in the bed in three cases (16%), and blunt trauma in three cases (kicking and the edge of the bed) (16%). Pain and swelling were present in all of the patients. In 15 patients (or 83%), there was evidence of penile deviation. At presentation, 15 (72%) patients reported experiencing rapid detumescence, discomfort, and penile swelling after hearing a cracking (popping) sound. None of these individuals experienced urine retention or urethral hemorrhage, and all were emptied on their own following the episode. Physical examination showed penile ecchymosis, swelling, and substantial discomfort when the penile shaft was examined. All but three patients had an evident penile deformity. Surgery was performed under spinal anesthesia in 14 (77.7%) patients. Four patients with a delayed presentation (more than 1 week) were managed conservatively.

Conclusion

As a true urologic emergency, penile fractures should be treated immediately to reduce pain and swelling and ensure better functional and esthetic outcomes. Despite taking more time, a subcoronal circumcising degloving incision is the ideal method because it is exploratory and esthetically pleasing.

Beyond the Breaking Point: A Unique Case Report of a Penile Fracture With a Distal Urethral Injury

A penile fracture is a rare urological emergency, often resulting from blunt trauma to the erect penis. This case report describes a 30-year-old male who presented with penile swelling during sexual intercourse, raising suspicion of a penile fracture. The patient underwent surgical exploration, revealing a rent in the tunica albuginea and an additional laceration in the corpus spongiosum with the Foley catheter exposed. The lacerations were closed using Vicryl sutures over a Foley catheter. The patient experienced an uneventful postoperative course, and follow-up assessments showed satisfactory healing of the urethra. This case underlines the need for clinicians to consider the possibility of urethral involvement in cases of penile fracture, as timely surgical intervention can prevent long-term sequelae such as erectile dysfunction and urethral strictures. By sharing this case, we hope to further emphasize the need for vigilance and swift action when faced with potential penile fractures in clinical practice.

Improving clinical diagnostic accuracy and management of False penile fractures characterizing typical clinical presentation: a systematic review and meta-analysis

PURPOSE

False penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea's injury, with or without lesion of dorsal penile vein. Their presentation is often indistinguishable from true penile fractures (TPF). This overlapping of clinical presentation, and lack of knowledge about FPF, can lead surgeons often to proceed directly to surgical exploration without further examinations. The aim of this study was to define a typical presentation of false penile fractures (FPF) emergency, identifying in absence of "snap" sound, slow detumescence, penile shaft ecchymosis, and penile deviation main clinical signs.

METHODS

We performed a systematic review and meta-analysis based on Medline, Scopus and Cochrane following a protocol designed a priori, to define sensitivity of "snap" sound absence, slow detumescence and penile deviation.

RESULTS

Based on the literature search of 93 articles, 15 were included (73 patients). All patients referred pain, most of them during coitus (n = 57; 78%). Detumescence occurred in 37/73 (51%), and all patients described detumescence occurrence as "slow". The results show that single anamnestic item have a high-moderate sensibility in the diagnosis of FPF, and the highest sensitive item was penile deviation (sensibility = 0.86). However, when more than one item is present, overall sensitivity increases greatly, closing to 100% (95% Confidence Interval 92-100).

CONCLUSION

Surgeons can consciously decide between additional exams, a conservative approach, and rapid intervention using these indicators to detect FPF. Our findings identified symptoms with excellent specificity for FPF diagnosis, giving clinicians more useful tools for making decisions.

Delayed approach of a penile fracture with encapsulated hematoma

Penile fracture (PF) is defined as the rupture of the tunica albuginea (TA) of the corpora cavernosa (CC) caused by trauma to the erect penis. We present a case and clinical evolution of the delayed approach of PF. Physical examination showed a ventral rounded mass in the middle surface of the penile shaft, associated with mild discoloration and edema. Surgery was performed with a vertical penoscrotal incision. We found an encapsulated hematoma on the right ventral mid penile shaft connected at its base to an approximate 1 cm transverse defect on the TA and we performed debridement and excision of the hematoma. Tunical defect was repaired with PDS 3/0 simple suture. The patient had a great postoperative evolution without local complications. The early diagnosis and surgical treatment reaches better functional results, with maintenance of erectile function in patients with penile fracture.

The presentation and outcomes of penile fracture with associated urethral injury: A systematic literature review

PURPOSES

Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to address the current literature concerning the etiology, presentations, intra-operative findings, site of injury, and complications of PF with associated urethral injury, Materials and Methods: The present systematic review was limited to human-based studies published in English language, and reporting clinical data on PF cases with associated urethral injuries. A comprehensive search of the literature was conducted on five electronic databases from their inception to May 2022: Medline via PubMed, Web of Science, Google Scholar, Scopus, and EBSCO host.

RESULTS

A total of 15 studies were included encompassing 1671 patients with PF. Out of 1665 patients with PF retrieved from the case series studies, 65 patients had associated urethral injuries giving a point prevalence of 3.9%. The vast majority of the patients had blood on the meatus and hematuria suggestive of urethral injury (57/59; 96.6%). Forty patients had partial urethral disruption and the rest of the patients had a complete rupture. All patients received primary urethroplasty as the main modality of treatment. The median hospital stay was two days and the median duration of transurethral catheterization was 21 days. Five patients (8.5%) developed urethral stricture; other complications included penile curvature (6.7%), palpable fibrosis (6.7%), and erectile dysfunction (3.4%).

CONCLUSIONS

Urethral injuries are uncommon, but serious findings, in patients with PF. Primary urethroplasty appears to achieve satisfactory outcomes with a low incidence of short and long-term complications.

Urethrography for diagnostic of penile fracture with ruptured anterior urethra and right corpus cavernosum

Penile fracture is a rare urological emergency that effect due to blunt trauma on erect penis. Mostly often occurs during sexual intercourse and is rare in blunt of trauma from impact at penile. That trauma it can caused by rupture and hematoma of tunica albuginea. In physical examination, we found swelling and hematoma of penile shaft, with abnormal angulation to the right and tenderness. Two hours after sexual intercourse, patient urinated and he felt fresh blood comes out with urine and it is painful. Penile fracture can be diagnostic with clinically and imaging radiology. Important information due clinically with précising radiologist finding can making the correct diagnosis and surgical procedure can be done immediately.

Penile fracture revealed by acute painless swollen scrotum: Case report

Penile fracture (PF) is a relatively common trauma described in the literature. When occurred during a blunt sexual trauma, clinical findings are classical. We report our first case managed at a rural hospital of West Cameroon region. This was a case of PF without eggplant deformity nor pain but a swollen scrotum (SS) and auto-medication history. PF was confirmed by ultrasound; indication for surgery was established. Surgery and postoperative period were uneventful. Acute painless SS could reveal PF, but the absence of spontaneous pain when PF is suspected suggests an investigation looking for the use of pain killers.

Traumatic Metachronous Penile Fracture to the Contralateral Corpora

Penile fracture is an uncommon condition in day-to-day urological practice. Though most cases of penile fracture are traumatic in nature, these are typically unilateral. Synchronous bilateral cases have been rarely reported. We present the third case recorded to date, to the best of our knowledge, of a metachronous penile fracture to the contralateral corpora due to trauma related to sexual intercourse. The first presentation demonstrated a significant tear to the left corporal body at surgical exploration that was repaired. There was no postoperative complications or erectile dysfunction on outpatient follow-up. Six months thereafter, the patient had another similar presentation and demonstrated a right corporal body fracture which was repaired surgically on an urgent basis. Prompt diagnosis and low threshold for surgical intervention are essential to reduce morbidity and prevent long-term complications.

Sexual Function Outcomes After Surgical Treatment of Penile Fracture

Introduction

Penile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection.

Aim

Our study aims to evaluate patients with penile fracture and to identify the factors that may influence the sexual function after surgical repair.

Methods

A total of 138 patients who were diagnosed with penile fracture between January, 1999 and December, 2018 were reviewed. Clinical features, perioperative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed.

Main Outcome Measures

Sexual function was evaluated by three parameters six months after surgical repair: International Index of Erectile Function-5 (IIEF-5) questionnaire, penile curvature and the presence of a painful intercourse. All factors that could potentially influence these parameters were analyzed.

Results

The mean age was 31.2 years (19-55). Presentation delay ranged from 1 to 5 days (mean = 16.8 hours) while surgery delay was 14.3 hours ().The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 62 cases (44.9%). On multivariate analysis, we found that the presentation delay and the fracture site located in the proximal shaft of the penis showed significant difference in the occurrence of postoperative ED (P = 0.03 and P = 0.015 respectively). Presentation delay, elective incision and tuncial leak located in the proximal shaft (P = 0.045; P = 0.018 and P = 0.022 respectively) were associated with higher penis curvature.

Conclusion

Immediate surgical repair and circumferential degloving incision for tunical leaks located in the proximal shaft of the penis are recommended in order to decrease the incidence of ED after surgical repair of penile fractures. Ouanes Y, Saadi MH, Alouene HH, et al. Sexual Function Outcomes After Surgical Treatment of Penile Fracture. Sex Med 2021;9:100353.

Findings regarding non-sexual penile fracture in a referral emergency hospital

Purpose:

To describe penile fracture (PF) findings with non-sexual etiology in a referral emergency hospital, with emphasis on demographic data, clinical and intraoperative findings and long-term outcomes.

Materials and Methods:

Patients with PF of non-sexual cause operated at our institution from January 2014 to January 2019 were submitted to surgical treatment and monitored for at least three months after surgery. Etiology of trauma, epidemiological and clinical presentation data, time to intervention and operative findings were reviewed retrospectively. The evaluation of postoperative erectile function was carried out by filling out the International Index of Erection Function - 5 (IIEF-5). The tool used to assess urinary function was the International Prostate Symptom Score (IPSS) questionnaire.

Results:

Of a total of 149 patients submitted to surgical treatment for PF, 18 (12%) reported non-sexual etiology. Twelve (66.6%) cases were due to penile manipulation through the act of bending the penis during morning erection, three (16.6%) when rolling over in bed with erect penis, one (5.5%) when embracing the wife during erection, one (5.5%) to laying on the partner with erect penis and the other (5.5%) when sitting on the toilet with an erection. Operative findings were unilateral corpus cavernosum injury in all cases. Only one (5.5%) patient had a partial urethral lesion. Follow-up time varied from 3 to 18 months (mean, 10.1 months). Three (16.6%) patients developed erectile dysfunction six months after surgery. However, all of them responded to treatment with IPDE-5 and reported improvement of erection, with no need for medication, on reevaluation after 18 months. One (5.5%) patient developed penile curvature < 30 degrees. Thirteen (72.2%) patients developed penile nodules. No patient presented voiding complaints during follow-up.

Conclusions:

PF is a rare urologic emergency, especially with the non-sexual etiology. However, PF should always be considered when the clinical presentation is suggestive, regardless of the etiology. Penile manipulation and roll over in bed were the most common non-sexual causes. These cases are related to low-energy traumas, usually leading to unilateral rupture of corpus cavernosum. Urethral involvement is uncommon but may be present. Early treatment has good long-term clinical outcome, especially when performed in specialized centers with extensive experience in FP.

A case of traumatic penile fracture with simultaneous rupture of both corpora cavernosa and complete urethral transection

Penile fracture is a rare injury to the penis caused by blunt trauma. The presence of urethral injuries sustained during fracture is less than 10%, but very few cases involve complete circumferential urethral transection. We present a case of a patient who presented with traumatic penile fracture involving bilateral corporal cavernosa injury and complete urethral transection.

Lessons learned after 20 years' experience with penile fracture

Objective:

To report our experience over the past 20 years in the diagnosis and surgical treatment of penile fracture (PF).

Materials and methods:

Between January 1997 and January 2017, patients with clinical diagnosis of PF were admitted to our facility and retrospectively assessed. Medical records were reviewed for clinical presentation, etiology and operative findings. Postoperative complications, sexual and urinary function were evaluated.

Results:

Sexual trauma was the main etiological factor, responsible for 255 cases (88.5%): 110 (43.1%) occurred with the “doggy style” position, 103 (40.3%) with “man on top” position, 31 (12.1%) with the “woman on top” position and 11 (4.3%) in other sexual positions. The most common findings in the clinical presentation were hematoma, in all cases and detumescence in 238 (82.6%). Unilateral corpus cavernosum injuries were found in 199 (69%) patients and bilateral in 89 (31%) patients. Urethral injuries were observed in 54 (18.7%) cases. Nine (14.7%) patients developed erectile dysfunction and eight (13.1%) had penile curvature. Only two (3.7%) patients had complications after urethral reconstruction.

Conclusions:

PF has typical clinical presentation and no need for additional tests in most cases. Hematoma and immediate penile detumescence are the most common clinical findings. Sexual activity was the most common cause. The ‘doggy style’ and ‘man-on-top’ was the most common positions and generally associated with more severe lesions. Concomitant urethral injury should be considered in cases of highenergy trauma. Surgical reconstruction produces satisfactory results, however, it can lead to complications, such as erectile dysfunction and penile curvature.

Urethral injury in penile fracture: a narrative review

Objective

To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury.

Materials and Methods

We searched the Pubmed database between 1998 and 2019 using the following key words: “penile fracture”, “fracture of penis”, “trauma to penis”, “rupture of corpora cavernosa”, “urethral injury”, “urethral rupture” and “urethral reconstruction”.

Results

The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula.

Conclusion

PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Importance of time in management of fracture penis: A prospective study

Background:

The presentation of penile fracture may vary depending on the delay to seek medical attention and on the presence of associated injuries. Delay in presentation has been linked previously to embarrassment associated with this condition.

Aims and Objectives:

The study aims to share our clinical experience in management of penile fracture and its complications and specifically highlights the impact of time delay on post-operative outcome in patients presenting with penile fracture.

Material and methods:

The study is a prospective observational study conducted from July 2014 till January 2017. All the patients presenting to the emergency with a clinical presentation of penile fracture and a tear in the tunica albuginea of the penile cavernosal tissue, confirmed on ultrasound were included in this study and intraoperative and postoperative data was analysed.

Results:

The most common cause for fracture noted was coitus. The average time delay from the time of insult to presentation to the emergency department was 25.11 ± 12.48 hours. The parameters that have significantly been altered by a time delay of more than 24 hours include post-operative wound infection, erectile dysfunction at 1-year, post-operative hospital stay. Two patients develop chordee at 6 and 9 months respectively and both patients presented beyond 24 hours. All patients with hematoma size on color Doppler of more 10cc and intraoperative tear >10mm had developed post-operative wound infection. Patients with urethral injury or post-operative cavernositis or wound infection had significant association with erectile dysfunction.

Conclusion:

Penile fracture although a rare urologic emergency, it has a significant impact on sexual health of a young man. An early intervention along with identifying and managing early complications factors would help patients of fracture penis lead an almost normal sexual life.

Penile refracture: a preliminary report

Objective:

To report our institutional experience with penile refracture, including demographic data, recurrence time, etiology and operative findings in the first and second episodes.

Materials and methods:

Between January 1982 and September 2017, 281 patients underwent surgical treatment for penile fracture (PF) at our institution. Demographic data, clinical presentation, besides operative findings and follow-up of patients with relapsed PF were retrospectively assessed by reviewing medical records.

Results:

Of a total of 281 cases of PF operated at our institution, 3 (1.06%) patients experienced two episodes of trauma. Age ranged from 38 – 40 years (mean: 39.3). The recurrence time varied from 45 to 1560 days (mean: 705). Two patients presented the new fracture episode at the same site of the previous lesion, while in the other case the lesion was observed at another site.

Conclusion:

Recurrent FP is an extremely rare entity. The risk factors for its occurrence are still unknown. Although the lesion of the corpus cavernosum ipsilateral to the scar tissue of the prior FP is more common, contralateral rupture may be present. Nevertheless, prospective studies with larger samples should be conducted.

Sexual complications of penile frature in men who have sex with men

Objectives:

Evaluate the demographic data, etiology, operative findings and results of surgical treatment of penile fracture (PF) in men who have sex with men(MSM) with emphasis on sexual complications.

Materials and Methods:

We studied 216 patients underwent surgical correction of PF at our hospital. Patients self-identified as MSM were followed for at least 6 months. Demographic data, presentation, operative findings, International Index of Erection Function - 5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool.

Results:

Of 216 PF cases, 4 (1.8%) were MSM. All cases resulted from sexual activity and all patients reported using the “doggy style” position during anal intercourse. Unilateral or bilateral injury of corpus cavernosum was found in 2 patients each. One (25%) patient had complete urethral injury associated with bilateral corpus cavernosum lesion. During the follow-up period, all patients developed some type of sexual complication. One patient reported penile pain during intercourse. Another patient experienced low sexual desire and premature ejaculation. This patient was also dissatisfied with the aesthetic result of the surgical scar and complained about decreased penis size after surgery. The third case developed delayed ejaculation. The fourth patient experienced mild to moderate erectile dysfunction. This same patient presented with penile curvature. Finally, palpable fibrotic nodules in the operative area were observed in all cases.

Conclusions:

Sexual activity in the “doggy style” position was the commonest cause of PF in MSM. Sexual dysfunction is always present in gay man after surgery for PF. However, additional studies with larger samples should be coinducted.

Primary urethral reconstruction results in penile fracture

Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.

Current Management of Penile Fracture: An Up-to-Date Systematic Review

INTRODUCTION

Because of the low incidence of penile fracture, many aspects of the diagnostic process and of the surgical and functional outcomes are rarely reported.

AIM

To systematically review the current literature on the surgical management of penile fracture, focusing on etiology, diagnosis, functional outcomes, and postoperative complications.

METHODS

The present review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms penile fracture, fracture of penis, trauma of penis, rupture of corpora cavernosa, and immediate management of penile fracture was been carried out in the PubMed, EMBASE, Cochrane, SCOPUS, and Science Citation Index databases.

MAIN OUTCOME MEASURES

Etiology of penile fracture, clinical presentation, types of radiologic investigations and their accuracy, surgical approach, suture material used for tunica repair, timing of surgical exploration, intraoperative findings, surgical complications, and functional outcomes.

RESULTS

The total number of patients analyzed was 438, and the patients' an average age was 36 years. The most frequent reported cause of penile fracture was sexual intercourse (80% of cases). The most common finding at examination was a penile hematoma (97.5%). Although operator dependent, in experienced hands, ultrasonography was found to be a useful tool in confirming the location of the albuginea tear and identifying the presence of any concomitant urethral injury, helping the surgeon to choose the best surgical approach. Early surgical repair of a penile fracture was found to be a safe procedure, although long-term complications are not uncommon. Tertiary referral centers that managed a larger number of cases seemed to obtain more satisfactory long-term results with a significantly smaller number of complications.

CONCLUSION

A low incidence of postoperative complications and full satisfactory functional outcomes are reported when early repair is performed in high-volume centers. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current Management of Penile Fracture: An Up-to-Date Systematic Review. Sex Med Rev 2018;6:253-260.

Relationship between sexual position and severity of penile fracture

The objective of the study was to evaluate the relationship between the sexual position and severity of penile fracture (PF). We studied 90 patients with PF. The mechanism of injury and the sexual position was assessed. We divided our sample by the etiology of the fracture in six groups: (a) masturbation or penile manipulation; (b) 'man-on-top' position; (c) 'doggy style' position; (d) 'woman-on-top' position; (d) blunt trauma; and (e) 'rolling over' fracture. We used the χ²-test for contingency analysis of the populations under study (P<0.05). The patient's age ranged from 18 to 66 years (mean 39 years). Investigation of the injury mechanism identified sexual trauma as the main etiological factor, involved in 69 cases (76.5%). The sexual position at the time of injury varied, with 23 cases (25.5%) occurring in the 'man-on-top', 37cases (41%) in the 'doggy style' and 9 cases (10%) in the 'woman-on-top'. We do not observe differences between the severity of the PF between the 'doggy style' and 'man-on-top' (P=0.9595), but the 'doggy style' had more severity of PF when compared with 'woman-on-top' (P=0.0396) and penile manipulation (P=0.0026). The 'man-on-top' and 'doggy style' positions showed more associations with bilateral fractures of the corpus cavernosum and urethral lesions.

Penile fracture: role of ultrasound

Penile fracture is a rare surgical emergency which requires prompt diagnosis and immediate surgical repair. In most cases the diagnosis is clinical however, in equivocal cases ultrasound examination can help in establishing the diagnosis by demonstrating the site and extent of tunica albuginea disruption. In this article, we are presenting sonographic findings in two cases of penile fractures.

Penile Fracture: A Meta-Analysis

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.

Fracture of the Penis: Demonstration by MRI with Surgical Correlation

MRI of a 21-year-old man with a penile fracture demonstrated disruption of the tunica albuginea and adjacent hematoma. Both MRI and subsequent retrograde uretrogram showed that the urethra was not injured. The imaging findings were confirmed at surgery, and the penis was successfully repaired.

Penile fracture with two ipsilateral corporal tears and delayed presentation: A case report

Although penile fracture is an infrequent injury, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that mandates immediate surgical exploration. Reported cases are usually single tear unless contralateral corporal tear is present. We present a case of 56-year-old with intraoperative findings of two separate tears in the same corpus cavernosum. Clinical presentation was also delayed for 4 days post-injury and repair was performed on day 7. This case accentuates the need for a high index of suspicion to rule out concomitant ipsilateral tear. Delayed repair was possible, and full recovery ensued.

Traumatic penile injury: from circumcision injury to penile amputation

The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.

Isolated rupture of the superficial vein of the penis

Penile emergencies are rare but when they do occur, prompt diagnosis and treatment are warranted. Emergent conditions of the male genitalia are mainly traumatic, vascular or infectious. Penile emergencies are usually caused by trauma to the penis, during sexual intercourse or manipulation of an erect penis during masturbation. One of the traumatic vascular penile emergencies is superficial penile dorsal vein rupture. This is a rare condition, with just a few reported cases. It is usually taken into differential diagnosis with the other acute penile injuries that present, such as acute penile edema or ecchymosis. We report a case of 59-year-old male with a superficial penile dorsal vein rupture which occurred during manipulation of the erect penis.

Penile fracture with urethral trauma

We reported a case of a twenty-nine-year-old male who presented a penile fracture associated with urethral injury caused by a sexual intercourse. An ideal anamnesis and a special physical examination were determinant to correct diagnostics. Ultrasonography and uretrocistography must be performed for confirmation. The treatment is based on the presence of associated urethral injury. The surgical repair of cavernous body and urethra can produce good results, with a favorable prognosis and minimal rate of complications.

Evaluation of epidemiology, concomitant urethral disruption and seasonal variation of penile fracture: A report of 86 cases

INTRODUCTION

Penile fracture (PF) is a well-recognized clinical entity and is often deemed a urological emergency. It is not uncommon in our region. The main objective of this study is to describe the clinical characteristics of patients diagnosed with penile fracture in the Qom Province, Iran. We evaluate surgical treatment, concomitant urethral disruption and its seasonal variation.

METHODS

This is a descriptive retrospective study, reviewing all the medical records of patients admitted with penile fracture from 2003 to 2012 at Kamkar Hospital of Qom, Iran. It takes into account variables related to the urological history, etiology, diagnosis and its surgical treatment. The epidemiologic data, marriage status and the seasonal variation were evaluated. In total, 86 patients, aged between 17 and 62, with PF were hospitalized in our centre. The average age of patients was 36.74 years. All operated cases were followed 3 months and 6 months after surgery.

RESULTS

Of the 86 patients, 34 (68%) were the ages of 20 and 40. In terms of marital status, 56 (65%) were married and 30 (35%) were single at the time of presentation. Twenty-six patients (30.2%) had episodes related to intercourse and 48 patients (56%) to manual habitual trauma; the remaining 12 patients had a direct blow to an erect penis or rolled/fell off a bed. Patients presented with swelling, pain and a popping or cracking sound in the penis. The diagnosis was made using history and physical examination in all patients. Unilateral corporeal ruptures were present in 80 (93%) and bilateral in 2 cases (2.32%). Surgical repair was performed with a circumferential sub-coronal degloving incision in 82 cases (95.35%). There were seasonal variations: 22 cases in spring; 25 in summer; 17 in autumn; 22 in winter. Patients had an average postoperative hospital stay of 1 day.

CONCLUSION

Habitual manual trauma was the most common cause of PF in our study. Immediate surgical intervention has low morbidity, short hospital stay and rapid functional recovery. In the case of urethrorhagia, concomitant urethral injury should be evaluated. On the basis of our study, PF may have seasonal variation.

Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis

Purpose

Early surgical management is the standard of care for penile fracture. Conservative treatment is an option with recent reports revealing lower success rates. We reviewed the data and long-term outcomes of patients with penile injury submitted to surgical or conservative treatment.

Materials and Methods

Between January 2004 and February 2012, 42 patients with penile blunt trauma on an erect penis were admitted to our center. We analyzed the following variables: age, etiology, symptoms and signs, diagnostic tests, treatment used, complications and erectile function during the follow-up. One patient was excluded due to missing information. Thirty-five patients underwent surgical repair and 6 patients were submitted to conservative management.

Results

Mean follow-up was 19.2 months (range, 7 days to 72 months). The mean elapsed time from trauma to surgery was 21.3±12.5 hours. Trauma during sexual relationship was the main cause (80.9%) of penile fracture. Urethral injury was present in five patients submitted to surgery. Dorsal vein injury occurred in three patients with false penile fracture and concomitant spongious corpus lesion was present in three patients. During follow-up, 31 cases (88.6%) of the surgical group and four cases (66.7%) of the conservative group reported sufficient erections for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining two patients (33.3%) from the conservative group developed erectile dysfunction and three patients (50%) developed penile deviation.

Conclusions

Surgical approach provides excellent functional outcomes and lower complications. Early surgical management of penile fracture provides superior results and conservative approach should be avoided.

Fracture penis: a case more heard about than seen in general surgical practice

A 36-year-old man presented to the emergency department with a history of trauma to genitalia during intercourse. The patient reported the forceful collision between his penis and the bed and audible clicking sound with swollen penis thereafter. On examination, the genitalia was swollen with an 'S' shaped deformity. The skin over the swelling was apparently normal, with no local rise of temperature. A provisional diagnosis was made after clinical evaluation. Scrotum and testes examination revealed no abnormality. A subcoronal circumferential incision with de-gloving of penile skin was used to access the tunica. A rent in tunica albuginea and corpora cavernosa identified and the defect repaired with absorbable suture material after removal of clot and properly maintaining haemostasis. The patient's postoperative recovery was uneventful. The following case report demonstrates a typical case of fracture penis.

Beneficial influence of topical extra virgin olive oil application on an experimental model of penile fracture in rats

Penile fracture (PF) is known as a traumatic rupture of the tunica albuginea of corpus cavernosum. In this study, we aimed to investigate the healing influence of topical extra virgin olive oil (EVOO) on PF through evaluating levels of some oxidative stress biomarkers for the first time. Histopathological evaluation was also realized. A total of 18 male Sprague-Dawley albino rats were divided into three groups of six rats each as control group, in PF (alone) group, and PF + EVOO group. Experimental PF was formed via incising from the proximal dorsal side of the penis in the rats of all groups except control. While in PF (alone) group, fracture was formed and the incision was primarily closed, in PF + EVOO group in addition to foregoing processes, EVOO was also administrated topically twice a day for 3 weeks. At the end of the experiment, all rats were killed and penectomy was carried out. While malondialdehyde, myeloperoxidase, lipid hyroperoxide, and total oxidant status significantly (p < 0.05) increased, reduced glutathione and total free sulfhydryl groups markedly (p < 0.05) decreased in PF (alone) group when compared with PF + EVOO group. Levels of these parameters were reversed to nearly normal values by topical EVOO application. Protection by EVOO is further substantiated via the improved histological findings in PF + EVOO group as against degenerative changes in the rats of PF (alone) group. Our data revealed that EVOO has protective effect in penile cavernosal tissue through probably its antioxidant, free radical defusing, anti-inflammatory, and antimicrobial effects.

La fracture de verge à Dakar. À propos de 25 cas

Buts

Présenter les caractéristiques épidémiologiques, cliniques et thérapeutiques des fractures de verge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar.

Matériels et méthode

Il s’agit d’une étude descriptive portant sur 25 cas de fracture de verge pris en charge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar entre janvier 2001 et décembre 2011. Les paramètres suivant ont été étudiés: l’âge, la résidence, les antécédents, les données cliniques, les données de l’exploration chirurgicale et les résultats du traitement.

Résultats

En dix ans, 25 cas de fractures de verge ont été enregistrés soit une moyenne de 2,5 cas par an. L’âge moyen de survenue était de 36 ans avec des extrêmes de 22 et 60 ans. Les circonstances de survenue sont dominées par les manipulations forcées (52 %) et les rapports sexuels (32 %). La douleur associée à une latérodéviation controlatérale de la verge, une tuméfaction localisée de la verge ou extensive à la région sus-pubienne ou périnéale sont les principaux signes retrouvés. Une prise en charge urgente (délai moyen de prise en charge de deux heures avec des extrêmes de 45 minutes et 48 h) en milieu chirurgical avec réparation des corps caverneux et albuginorraphie a été la règle.

Conclusion

La fracture de verge est une urgence urologique relativement peu fréquente dans notre contexte. Son diagnostic reste aisé et est essentiellement clinique. Une prise en charge précoce et correcte en milieu chirurgical est garante d’un bon résultat fonctionnel et esthétique.

Point-of-care ultrasound used to exclude penile fracture

This is a case report of a superficial penile hematoma that was difficult to distinguish clinically from a penile fracture. Such cases occur with relative frequency, and because definitive treatment is an urgent surgery, timely diagnosis is essential to avoid complications. Typical imaging modalities such as cavernosonography and magnetic resonance imaging can be invasive (cavernosonography) or time consuming (magnetic resonance imaging) and may not be readily available. Ultrasound has been used successfully in such cases, and, in this case, we used point-of-care ultrasound combined with a brief period of observation to exclude penile fracture.

Penile fracture: long-term results of surgical and conservative management

BACKGROUND

Penile fracture usually results from direct trauma to the erected penis. We evaluate the outcomes of surgical and conservative treatment.

METHODS

Between February 2000 and February 2007, 77 patients with mean age 29 ± 2.5 years (range, 20-57 years) with penile fracture were evaluated retrospectively. A total of 56 patients (group A) were treated with immediate surgical repair and 21 patients (group B) were treated conservatively as they refused surgical intervention. Data on erectile function and any penile sequel were obtained during follow-up using the International Index of Erectile Function (IIEF-15) questionnaire, local examination, and color Doppler ultrasonography reports.

RESULTS

Only 69 patients were available for median follow-up period of 20.8 months (range, 17-30 months), 51 patients of the group A and 18 of the group B. Injury involved unilateral and bilateral corporeal rupture in 50 and 6 cases, respectively. Concomitant urethral injury was detected in three cases. During follow-up, 49 cases (96%) of the surgical group (A) and 9 cases (50%) of the conservative group (B) reported erection adequate for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining nine patients (50%) from the conservative group (B) reported erectile dysfunction and penile deviation.

CONCLUSIONS

Immediate surgical repair of the penile fracture gave good results and is superior to conservative treatment; however, we cannot distinguish false from true penile fracture accurately to determine on whom we can use the conservative treatment.

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

This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, >50 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, >50 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.

Long-term significance of the number of hours until surgical repair of penile fractures

OBJECTIVES

We investigated whether a delay in time until surgery, in terms of hours, has any effect on the overall long-term results of surgical repair of penile fractures.

METHODS

Between 2001 and 2009, we operated on 56 patients with penile fractures. We evaluated 43 patients sorted into 3 groups according to the time interval until surgery. We applied the validated Turkish version of the International Index of Erectile Function (IIEF) questionnaire 3 times: for the time period before the fracture, 1 year after the fracture, and at the time of the study. An erectile dysfunction score was calculated for every patient.

RESULTS

Overall, the mean follow-up was 46.1 ± 19.2 months. The mean number of hours from trauma to surgery was 11.3 ± 8.5. There was no statistically significant difference between the 3 groups in terms of age and length of tears. The results of the IIEF questionnaires of each group for time periods and for individual patients in each separate group were statistically similar.

CONCLUSIONS

Surgical repair has a good functional outcome and low complication rates in the long term. Neither serious deformities nor erectile dysfunction occur as a consequence of a delay in surgery in the long term in patients with no urethral involvement within a given period of time.

Surgical repair and analysis of penile fracture complications

BACKGROUND

The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture.

MATERIAL AND METHODS

From 2005 to 2009 the Urology Department of the Hospital Clínico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair.

RESULTS

From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1-5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%).

CONCLUSIONS

A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.