Sexual Function and Tunica Albuginea Wound Healing Following Penile Fracture: An 18-year Follow-Up Study of 352 Patients from Kermanshah, Iran

Abstract

Introduction We present a study on the experiences of penile fracture in an Iranian population. Aim To determine the long-term outcome of penile fracture. Methods Between April 1990 and May 2008, 373 patients presented with clinical features suggestive of penile fracture. Of these, 11 declined surgery. The remaining 362 were operated upon using a degloving incision. Ten patients had venous injury and 352 had penile fracture. At follow-up visits, in addition to answering our questionnaire, the patients completed the International Index of Erectile Function (IIEF), Erection Hardness Grading Scale (EHGS), and global self-assessment of potency (GSAP). To enhance documentation and to promote transparency, with the patients’ permission, their full name and hospital chart number was sent to the journal. Main Outcome Measures Clinical findings and IIEF and EHGS scores. Results Mean patients’ age was 29.6 years. Mean duration of follow-up was 93.6 months. Diagnosis was solely clinical. At presentation, 278 (78.9%) reported no pain. Cavernosography, ultrasonography, or magnetic resonance imaging was not used in any of the patients. Penile fracture was due to taqaandan in 269 patients (76.4%). Patients were treated with surgical exploration and repair within 24 hours of admission, regardless of delay in presentation. A nodule was found at follow-up in 330 patients (93.7%). The painless, mostly proximal nodule was palpated at the floor of the corpora cavernosa, in a deep midline position above the corpus spongiosum. The non-expansive nodule was not associated with erectile dysfunction (ED) or Peyronie’s disease. Postoperative complications included mild penile pain in cold weather (two patients), transient wound edema (one patient), mild chordee (four patients), and occasional instability of the erect penis (one patient). Postoperatively, of the 217 patients who had partners, 214 (98.6%) were potent. Mean IIEF ED domain score was 29.8 ± 1.1. The EHGS score was 4 in 203 and 3 in 11. The GSAP score was 0 in 204, 1 in 8, and 2 in 2. ED in the remaining three could not be explained by penile fracture. Of 10 nonoperated patients, eight (80%) developed ED. Conclusion Pain is rare in penile fracture. Postoperatively, almost all patients develop a permanent, inconsequential, fibrotic nodule. Our time-tested approach provided excellent long-term sexual function.

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

“…11,13 Contemporary series showed that the incidence of ED after surgical repair of fracture penis ranges from 0% up to 16.6%. 6,7,[13][14][15][16][17][18][19] Several important issues may be raised during discussing the development of ED after surgical repair of fracture penis. First, is delayed presentation after trauma a risk factor for ED?…”

Relationship between penile fracture and Peyronie's disease: a prospective study

“…The same researcher palpated nodules within the repair site in 93.7% of 352 patients with PF, who had undergone surgical treatment and monitored for 93.6 months without any physical examination evidence of Peyronie's plaque. 16 Similarly, in another study, no Peyronie's plaque could be found in 37 cases who were surgically treated for PF and followed for about 18 months. 17 On the other hand, in two separate controlled studies including 82 and 134 patients with PD, respectively, none of the cases had PF history.…”

“…In recent studies, development of the Peyronie's plaque in cases with PF treated surgically was assessed using only physical examination. [15][16][17] In this study, potential development of sequelas in tunica albuginea and intracavernosal septa of the cases treated surgically for PF within the last 20 years have been evaluated with physical examination, ultrasonography (US) and magnetic resonance imaging (MRI).…”

No evidence of depression, anxiety, and sexual dysfunction following penile fracture

“…On the other hand, they reported the development of ED in 8 patients (80%) out of 10 who had not received surgical repair. 20 In another study, Ibrahiem et al 5 reported the rate of ED as 7.8% (11/155) after treatment in patients with penile fracture. They explained the causes of ED in those 11 patients as follows: 4 patients had incompetent veno-occlusive mechanism, 3 patients had penile artery insufficiency, and 4 patients had psychogenic trauma, as their color duplex penile indexes were normal.…”

“…In earlier studies, reports of conservative management have shown that nonsurgical management in penile fracture is unacceptable and complication rate was higher than with surgery. 20 Although the hospital stay for patients treated conservatively averaged 14 days, this period is usually limited in surgical groups to 1-2 days. 21 Our results show that a mean hospital stay of 2.1 days is consistent with the literature and supports recommendations for a surgical approach to penile fracture.…”