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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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Peradejordi Font MR, Mercader Barrull C, López Martínez JM, Corral Molina JM, García Cruz E, Alcaraz Asensio A, Peri Cusi L. Consequences of penile fracture: Complications and long-term functional outcomes. Actas Urol Esp 2022; 46:178-183. [PMID: 35277377 DOI: 10.1016/j.acuroe.2021.12.008] [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: 08/11/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center. MATERIALS AND METHOD Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5 and morphological alterations by direct questions to patients. RESULTS A total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4% vs. 80%, p < 0.05). Only 1 patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and 1 patient with previous urethral injury presented urethral stricture. CONCLUSION In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare.
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Affiliation(s)
| | - C Mercader Barrull
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J M López Martínez
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J M Corral Molina
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - E García Cruz
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Alcaraz Asensio
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - L Peri Cusi
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
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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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Barros R, Schul A, Cavalcanti AG, Favorito LA, Koifman L. Findings regarding non-sexual penile fracture in a referral emergency hospital. Int Braz J Urol 2021; 47:388-394. [PMID: 33146978 PMCID: PMC7857745 DOI: 10.1590/s1677-5538.ibju.2020.0420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Rodrigo Barros
- Departamento de Urologia do Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil.,Universidade Federal Fluminense - UFF, Niterói, RJ, Brasil
| | - Alex Schul
- Departamento de Urologia do Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil
| | | | | | - Leandro Koifman
- Departamento de Urologia do Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil
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Pattern of presentation and surgical management of penile fractures in a semi-urban African teaching hospital: Case reports and literature review. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current Management of Penile Fracture: An Up-to-Date Systematic Review. Sex Med Rev 2017; 6:253-260. [PMID: 28874325 DOI: 10.1016/j.sxmr.2017.07.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Marco Falcone
- Urology Department, Città della Salute e della Scienza, Torino, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Fabio Castiglione
- The Institute of Urology, University College London Hospitals, London, UK
| | - David J Ralph
- The Institute of Urology, University College London Hospitals, London, UK.
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Injury to the male external genitalia: a comprehensive review. Int Urol Nephrol 2017; 49:553-561. [DOI: 10.1007/s11255-017-1526-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
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De Luca F, Garaffa G, Falcone M, Raheem A, Zacharakis E, Shabbir M, Aljubran A, Muneer A, Holden F, Akers C, Christopher N, Ralph DJ. Functional outcomes following immediate repair of penile fracture: a tertiary referral centre experience with 76 consecutive patients. Scand J Urol 2017; 51:170-175. [DOI: 10.1080/21681805.2017.1280532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Francesco De Luca
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - Giulio Garaffa
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - Marco Falcone
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
- Department of Urology, University of Turin, Turin, Italy
| | - Amr Raheem
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
- Department of Andrology, University of Cairo, Cairo, Egypt
| | - Evangelos Zacharakis
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - Majed Shabbir
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Abdelkareem Aljubran
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
- Armed Forces Hospital of South Region, Abha, Saudi Arabia
| | - Asif Muneer
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - Fiona Holden
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - Claire Akers
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - Nim Christopher
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
| | - David J. Ralph
- St Peter’s Andrology Centre and the Institute of Urology, University College London Hospital (UCLH), London, UK
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Vilson F, MacDonald S, Terlecki R. Contemporary Management of Penile Fracture: a Urologist’s Guide. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0069-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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