Mechanisms Predisposing Penile Fracture and Long-Term Outcomes on Erectile and Voiding Functions

Abstract

Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients' status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4%) were confirmed, mean age was 34.5 years (range: 18–60), mean follow-up 59.3 months (range 9–155). Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%), followed by penile manipulation (6 patients, 14.3%), and homosexual intercourse (4 patients, 9.5%). “Woman on top” was the most common heterosexual position (n = 14, 50%), followed by “doggy style” (n = 8, 28.6%). Four patients (9.5%) maintained the cause unclear. Six (14.3%) patients had urethral injury and two (4.8%) had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. “Woman on top” was the potentially riskiest sexual position (50%). Immediate surgical treatment warrants long-term very low morbidity.

Penile Fracture: A Meta-Analysis

“…There were no randomised trials and all studies were observational and generally of low quality. Only one study was prospective [11] with the remaining 57 being retrospective [1,2,3,5,8,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Twenty studies made direct comparisons between conservative and surgical management [5,11,12,13,15,19,20,21,25,31,36,38,39,40,42,43,47,51,55,59].…”

“…A widely held view is that the ‘woman on top' position poses the greatest risk to penile fracture although no systematic review has corroborated this. Analysing the literature would seem to suggest a geographical variation in the aetiology of penile fracture [3]. In some Middle Eastern countries, many reported cases are due to patients ‘kneading and snapping' the erect penis to achieve rapid detumescence in unsuitable situations [2,4,5].…”

An update of Penile Fractures: Long-term significance of the number of hours elapsed till surgical repair on long-term outcomes

“…For example, in a series from Europe rates of urethral involvement were reported as 14%-28%, whereas in series from Asia and Middle East rates lower than 2% were indicated. [14][15][16][17] The very low rates from Middle East may be explained by the habitual method to postpone the ejaculation by bending the erect penis manually, called taghaandan. [16] Urethroscopy and retrograde urethrography are the most frequently used modalities for the preoperative evaluation of the urethra.…”

Diagnosis and Treatment of Penile Fractures: A Single Center Series

“…Conservative treatment means loss of erectile function in 10% -30% of cases due to fibrous tissue formation [22] [23] [24] [25]. As a rule, penile fracture should be operated as an emergency [1] [2]. Our patients were advised to be abstinent from sexual intercourse for 2 -6 weeks.…”

“…(2017) Diagnosis and Treatment of Penile Frac-during erection. It is a rare urological emergency and immediate surgical repair is recommended to obtain optimal functional outcome and avoid complications [1] [2].…”