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

Abstract

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, 450 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, 450 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

Penile Fracture:Presentation, Management and Erectile Function Following Surgical Repair

“…Some investigators have recommended the use of ultrasound, carvernosography and magnetic resonance imaging to locate the site of the tunical tear before surgery. [3,4,5] In our study patient history and clinical examination were highly sensitive and accurate in predicting a cavernosal tear and radiological investigations did not influence patient management in any of the cases, this correlates well with other studies . [6][7][8][9][10][11] The only important imaging study is a retrograde urethrogram, which should be selectively performed to identify a concomitant urethral tear that occurs in approximately in 10-22% of reported cases.…”

“…The hospital stay ranged to an average of 3 days, which is comparable to other studies. [5,7,10] In our study seven (87.5%) of these patients reported achieving adequate erection for intercourse without erectile or voiding dysfunction. The patient who presented late at 15 days had erectile dysfunction and also had deformity of the penis.…”

“…[1,2] Conservative therapy restricted to uncomplicated cases also has a good outcome. [4,5] We present our experience with surgical treatment of penile fractures with special emphasis on postoperative erectile function.…”

Penile Fracture: A Meta-Analysis

“…Three studies used absorbable and non-absorbable on a case-by-case basis [5,37], 25 studies used only absorbable [1,2,11,14,15,16,17,20,21,25,27,31,35,36,39,40,42,43,44,46,49,53,58,59,62], 4 used only non-absorbable [8,13,48,52] and 18 did not specify the type of suture material used [3,12,18,19,22,23,26,28,29,30,32,34,38,45,47,50,51]. …”

“…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].…”