Lessons learned after 20 years' experience with penile fracture

Abstract

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 fi ndings. 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 fi ndings 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 fi ndings. 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.

Diagnostic performance of MRI and US in suspicion of penile fracture

“…The role of imaging in patients with suspected PF is controversial with some authors assuming that PF is mainly a clinical diagnosis and should be treated surgically without delay (2)(3)(4). Others report good diagnostic accuracies for magnetic resonance imaging (MRI) and ultrasound (US) (5,6).…”

“…Generally, many authors emphasize the importance of prompt surgery for PF (2)(3)(4)10). In a meta-analysis, Amer et al found that surgery significantly improved outcome compared with conservative therapy (10).…”

“…Penile fracture (PF) is a rare urologic emergency that is characterized by a rupture of the tunica albuginea enclosing the corpora cavernosa due to blunt trauma (1,2). Fracture is typically the result of an injury during intercourse or manipulation (3), causing, in most cases, a unilateral tear of the tunica albuginea (1,4). Common clinical symptoms are hematoma, detumescence, fracture sound, and pain (4).…”

“…Fracture is typically the result of an injury during intercourse or manipulation (3), causing, in most cases, a unilateral tear of the tunica albuginea (1,4). Common clinical symptoms are hematoma, detumescence, fracture sound, and pain (4).…”

Penile fracture: Tertiary care center experience and long‐term complications after immediate repair

“…6 It is stated that urethral injuries are mostly accompanied by bilateral rupture. 3,7 The diagnosis of penile fracture is made clinically. Color doppler ultrasonography (USG) and/or magnetic resonance imaging (MRI) of the penis and perineum can provide useful information about the location and size of the fracture.…”