Surgical or conservative treatment of penile fracture

Introduction: Penile fracture presents with rupture of corpora cavernosa. It is not rare but is remarkable. Treatment options are controversial. Aim: To establish the incidence, what are early and late complications in patients treated surgically or with conservative treatment options (prospective/retrospective and randomized analysis). To find out what therapy verified as superior. Material and method: The total of 32 patients with typical acute penile fracture were analyzed. The patients were between 20 and 56 years of age (Mean age 40+7.25 SD). A total of 11 patients that presented up to 48h after the rupture of tunica albuginea (34.37%) were operated, while 9 patients (28.13%) were conservatively treated. 12 patients (37.5%) reported to andrology consulting room due to penile fibrous alterations and/or erectile dysfunction 6 to 14 months after the anamnesticaly established, typical penile fracture ("primary latent penile fracture"). Both groups of patients were strictly clinically followed 3, 6, 9 and 12 months after the penile fracture. Eventual development of late complications (erectile dysfunction ED, penile curvature, induratio, caverno-urethral fistula and urethral stenosis) was also recorded. Etiology of ED was investigated: anamnesticaly, by hormone and laboratory analysis, using penodynamic test (PGE1), Duplex Doppler echosonography, and dynamic cavernosography. Results: In the operated group of patients, (11 pts, 34.37%) preserved erectile capacity was recorded and no penile deformity or plaque lesions on the site of suture, after the patients were recommended to have 4 weeks of sexual abstinence. The rupture of tunica albuginea was always transversal in relation to penile axis i.e. in relation to axial force against which the penis acts during the intercourse. The rupture is always on the basis or mid penile portion . Out of 21 (65.63%) conservatively treated patients in 13 (61.9%) plaque lesions (longitudinal diameter 2 cm) was recorded, while sexual dysfunction was established in 13 patients (12 with ED and 1 patient with incapability for vaginal penetration). Evaluation of post therapeutical complications in relation to type of treatment, significantly higher frequency was recorded in the group of conservatively treated patients (p<0.01). Penile veno-oclusive dysfunction was registrated as significantly most frequent cause of ED (in 10 - 76.92% out of 13 patients). All patients with ED had palpable fibrous lesion similar to Peyrone?s plaque, while the degree of penile deviation correlated to the size of plaque lesion. Conclusion: The late complications of penile fracture were significantly more frequently recorded in the group of conservative treated patients (p< 0.01) which proves that this lesion presents as urgent urological entity. The penile rupture is always transversal, and most probable place of rupture is physiological penile curve since this is the site of weakened structural integrity.

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Delayed Successful Surgical Repair of Penile Fracture: A Case Report

Current Urology ◽

10.1159/000489428 ◽

2018 ◽

Vol 12 (2) ◽

pp. 111-112 ◽

Cited By ~ 1

Author(s):

Ioannis Galanakis ◽

Konstantinos Adamos ◽

Evangelos Spyropoulos ◽

Stamatios Mavrikos

Keyword(s):

Surgical Treatment ◽

Tunica Albuginea ◽

Standard Of Care ◽

Late Complications ◽

Traumatic Rupture ◽

Penile Curvature ◽

Delayed Presentation ◽

Current Standard ◽

Penile Fracture ◽

Urological Emergency

Penile fracture is a very rare urological emergency resulting from traumatic rupture of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse. Immediate surgical treatment is the current standard of care with lower risks of late complications, including erectile dysfunction, penile curvature, and tunical scar formation. We, hereby, report an over delayed presentation (23 days) of a penile fracture, which was successfully managed surgically. Our case emphasizes on the fact that there are not any “lost” cases and surgical treatment should always be offered to penile fracture, independently of delayed presentation.

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Penile fracture in a 32-year old man with sexual dysfunction: A case report of rare outcome of the use of aphrodisiacs

GSC Biological and Pharmaceutical Sciences ◽

10.30574/gscbps.2021.14.1.0008 ◽

2021 ◽

Vol 14 (1) ◽

pp. 071-074

Author(s):

Paul O. Dienye ◽

Japhet Nwapi ◽

Alali Dan-Jumbo

Keyword(s):

Sexual Dysfunction ◽

Tunica Albuginea ◽

Standard Of Care ◽

Late Complications ◽

Traumatic Rupture ◽

Penile Curvature ◽

Current Standard ◽

Penile Fracture ◽

Urological Emergency ◽

Recreational Use

Penile fracture is a very rare urological emergency resulting from the traumatic rupture of the tunica albuginea of one or both corpora cavernosa. Immediate surgical treatment is the current standard of care with lower risks of late complications, including erectile dysfunction, penile curvature, and tunical scar formation. We report a case of a patient with sexual dysfunction who took a combination of Anafranil and Sildenafil to enhance his sexual performance to satisfy his girlfriend, but ended with a penile fracture. Our case exposes the degree of frustration suffered by patients with sexual dysfunction and the extent to which they can go in the quest for a solution to their problem, the outcome may be unfavorable.Patients should be informed about the possible complications of Sildenafil either used singly or co-administered with Anafranil for improved sexual function, and recreational use of these drugs should be discouraged.

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Penile fracture and investigation of early surgical repair effects on erectile dysfunction

Urologia Journal ◽

10.1177/0391560319844657 ◽

2019 ◽

Vol 86 (4) ◽

pp. 207-210

Author(s):

Bulent Kati ◽

Yigit Akin ◽

Mehmet Demir ◽

Omer Faruk Boran ◽

Kemal Gumus ◽

...

Keyword(s):

Erectile Dysfunction ◽

Erectile Function ◽

Surgical Repair ◽

Urethral Injury ◽

Penile Curvature ◽

Penile Fracture ◽

Direct Trauma ◽

Significant Difference ◽

The Mean ◽

Erect Penis

Objectives: Penile fracture is one of the urological emergencies caused by direct trauma to an erect penis during sexual intercourse, which results in a tear in the tunica albuginea within the corpus cavernosum. Serious complications such as penile curvature and erectile dysfunction may develop due to inappropriate and/or late surgical repair. This study aims to evaluate patients with penile fracture and to describe their demographics, surgical repairs, and long-term outcomes. Materials and Methods: A total of 56 patients who were diagnosed with penile fracture between January 2012 and June 2017 were reviewed. Clinical features, pre-operative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed. Early surgical management was performed. Outcomes, including International Index of Erectile Function 5 pre-operation and after 6 months, were evaluated. Results: The mean age was 30.2 (18–57) years. In etiological questionnaires, 32 (57.2%) patients reported direct trauma to an erect penis during intercourse. The mean size of tunica defects was 1.61 ± 0.42 (0.3–3.6) cm of the nine (16%) patients, and penile fracture was associated with urethral injury. There was no significant difference in International Index of Erectile Function 5 scores before the surgery and 6 months after surgery. Penile skin necrosis developed in one patient 10 days post-operation. Conclusion: Early surgical repair could be an effective method of achieving post-operative erection success in patients with penile fracture due to direct trauma during intercourse.

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Penile Fracture with Associated Urethral Rupture

Case Reports in Medicine ◽

10.1155/2010/791948 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 6

Author(s):

Nicholas A. Boncher ◽

Gino J. Vricella ◽

Jason T. Jankowski ◽

Lee E. Ponsky ◽

Edward E. Cherullo

Keyword(s):

Erectile Dysfunction ◽

Surgical Repair ◽

Potential Outcomes ◽

Urethral Injury ◽

Penile Curvature ◽

Penile Fracture ◽

Injury Treatment ◽

Key Aspects ◽

Urethral Rupture ◽

Erect Penis

Penile fracture of the erect penis is an uncommon but emergent urological trauma. Potential outcomes include erectile dysfunction, penile curvature, and urethral injury. Treatment is emergent surgical repair. We present the case of a 42-year-old man with a penile fracture complicated by a urethral rupture and subsequent repair. A discussion of the key aspects of this condition is presented.

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Fracture penis: rare occurrence

International Surgery Journal ◽

10.18203/2349-2902.isj20184656 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3747

Author(s):

Akhilesh Kumar Yadav ◽

Sankalp Dwivedi ◽

Sagar Bassi ◽

Sunil Kumar Singh

Keyword(s):

Blunt Trauma ◽

Tunica Albuginea ◽

Corpus Cavernosum ◽

Penile Curvature ◽

Corpus Spongiosum ◽

Penile Fracture ◽

Immediate Surgery ◽

Almost All ◽

Erect Penis

Fracture Penis is not usual. It is a tear in the tunica albuginea of the corpora cavernosa with or without involvement of corpus spongiosum and urethra. The usual cause is abrupt bending of the erect penis by blunt trauma, most commonly during sexual intercourse. A crackling sound, pain, detumescences, bruising, swelling, and bleeding per urethra are the common symptoms reported by the patients. Early surgical management is treatment of choice. Diagnosis of Penile Fracture refers to a rupture of the corpus cavernosum induced by blunt trauma to erect penis. Mainly diagnosed clinically from their stereotypical crackling sound from the erect penis at the moment of injury, rapidly followed by acute swelling, pain and penile deformity. Treatment recommendations include immediate exploration and repair. Surgical repair requires evacuation of hematoma, identification of tear, repair of the tear and ligation of any disrupted vasculature. Long term complications after repair include penile deviation, painful intercourse, painful erection and erectile dysfunction. The diagnosis of penile fracture is mostly clinical. Based on physical examination and typical crackling sound at the time of injury. Prompt surgical exploration and repair are advocated in almost all cases. Immediate surgery reduces long term complication which is post-traumatic penile curvature.

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Long-Term Results of Combined Tunica Albuginea Plication and Penile Prosthesis Implantation for Severe Penile Curvature and Erectile Dysfunction

Case Reports in Urology ◽

10.1155/2014/818623 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Luigi Cormio ◽

Paolo Massenio ◽

Giuseppe Di Fino ◽

Giuseppe Lucarelli ◽

Vito Mancini ◽

...

Keyword(s):

Erectile Dysfunction ◽

Tunica Albuginea ◽

Penile Prosthesis ◽

Long Term Results ◽

Penile Curvature ◽

Prosthesis Implantation ◽

Inflatable Penile Prosthesis ◽

Recommended Treatment ◽

Penile Plication

Penile prosthesis implantation is the recommended treatment in patients with penile curvature and severe erectile dysfunction (ED) not responding to pharmacotherapy. Most patients with mild-to-moderate curvature can expect cylinder insertion to correct both ED and penile curvature. In patients with severe curvature and in those with persistent curvature after corporeal dilation and prosthesis placement, intraoperative penile “modelling” over the inflated prosthesis has been introduced as an effective treatment. We report for the first time the long-term results of a patient treated with combined penile plication and placement of an inflatable penile prosthesis.

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Penile fracture in a Peyronie’s disease patient: a case report

African Journal of Urology ◽

10.1186/s12301-020-00054-5 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Nur Hidayatullah ◽

Khoirul Kholis ◽

Muhammad Asykar Palinrungi ◽

Syakri Syahrir ◽

Syarif Syarif ◽

...

Keyword(s):

Tunica Albuginea ◽

Disease Patient ◽

Clinical History ◽

Fracture Repair ◽

Peyronie’S Disease ◽

Penile Curvature ◽

Current Standard ◽

Penile Fracture ◽

Penile Plication ◽

Peyronie's Disease

Abstract Background Penile curvature in men with Peyronie’s disease (PD)—caused by tunica anchoring plaques with loss of focal fiber elasticity—theoretically increases the risk of penile fracture during sexual activity. Penile fracture is the result of tearing of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse, and is among the most serious urological emergencies. Generally, a patient presented to a surgical emergency within 48 h of injury can be handled successfully with minimum complications. Immediate surgical treatment is the current standard of care and has a relatively low risk of late complications. Case presentation We present a case of penile fracture in a male with a history of PD referred to the emergency department with severe pain. Clinical history assessment and physical examination revealed a penile fracture with underlying PD. He underwent emergency surgical exploration via subcoronal incision. Penile plication was not necessary for our case because the angulation of the penis was less than 15° after examination of artificial erection. Conclusion Penile fracture in a patient with underlying PD is a rare urological emergency that should be treated surgically with fracture repair as early as possible. Penile plication might be necessary in severe cases (angulation > 60°).

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OUTCOMES OF SURGICAL MANAGEMENT OF FRACTURE PENIS: EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN BANGLADESH

Public Health of Indonesia ◽

10.36685/phi.v5i4.313 ◽

2019 ◽

Vol 5 (4) ◽

pp. 122-130

Author(s):

Md. Selim Morshed ◽

AKM Musa Bhuyian ◽

Mohammad Saruar Alam ◽

Md. Towhid Belal ◽

Sayem Hossain ◽

...

Keyword(s):

Erectile Dysfunction ◽

Erectile Function ◽

Surgical Repair ◽

Tunica Albuginea ◽

Tertiary Care ◽

Self Report ◽

Care Hospital ◽

Penile Fracture ◽

Uncommon Presentation

Background: Penile fracture is an emergency and uncommon presentation to the urology department. Immediate surgical repair can be a standard of care for patients with penile fracture. Objective: The study was conducted to evaluate the outcome of surgical repair of the fractured penis.Methods: This quasi-experimental study was conducted from Jan 2017 to Dec 2018 in the urology department of Dhaka Medical College Hospital, Bangladesh. Thirty-five patients with fractures of the penis were included in this study. After proper evaluation, surgery was performed under spinal anesthesia. Follow up was scheduled at 6th week, 3rd month, and 6th month. We used validated questionnaires of the ‘International index of erectile function (IIEF-5)’ for married and ‘Single question self-report (SQSR)’ for unmarried patients to evaluate postoperative erectile function.Results: Total 35 patients completed three follow up. The mean age of patients was 36.4 years, and 88% of them were married. The most common triggers were for vigorous sexual intercourse (68.5%) followed by history of rolling over in bed with erect penis (20.0%). Per-operative findings were: rupture of tunica albuginea (100%); rupture of corpora cavernosa on the right (65.7%). After 6th month, 28 patients (80%) were able to maintain their normal erectile function. However, seven patients developed erectile dysfunction, of which 4 had a mild form, and 3 had mild to moderate form erectile dysfunction. All patients complained of pain during or after intercourse, but the pain has gradually subsided with time.Conclusion: Immediate surgical exploration and repair of fracture penis can offer complete recovery of sexual and voiding functions.

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Use of Li-ESWT, Tadalafil, and a Vacuum Device to Preserve Erectile Function in Subjects Affected by Peyronie’s Disease and Undergoing Grafting Surgery

Uro ◽

10.3390/uro1030019 ◽

2021 ◽

Vol 1 (3) ◽

pp. 187-194

Author(s):

Francesco Trama ◽

Antonio Ruffo ◽

Ester Illiano ◽

Giuseppe Romeo ◽

Filippo Riccardo ◽

...

Keyword(s):

Erectile Dysfunction ◽

Erectile Function ◽

Tunica Albuginea ◽

Penile Prosthesis ◽

Peyronie’S Disease ◽

Penile Curvature ◽

Rehabilitation Protocol ◽

Extracorporeal Shock Wave ◽

Vacuum Device ◽

Peyronie's Disease

Background: Peyronie’s disease (PD) is a little-known disease characterized by pain during erections, the presence of penile curvature, and consequent psychological disorders. In addition, concomitant erectile dysfunction may be present. The treatment of PD is adapted to the patient, especially when the penile curvature is >60°; with stabilized pathology, it is preferable to perform penile straightening approaches, such as penile plication and plaque incision, or partial excision and grafting. The most frequent side effect of straightening approaches is the onset of erectile dysfunction due to the formation of venous leakage appearing after the excision of calcific plaque. Materials and methods: All enrolled patients had PD, a curvature >60°, had an IIEF subdomain erectile function score >16, and refused penile prosthesis implantation concurrent with tunica albuginea grafting surgery. Subsequently, 4 weeks after surgery, all patients underwent a rehabilitation protocol that consisted of low-intensity extracorporeal shock wave therapy (Li-ESWT), the administration of 5 mg/daily of tadalafil, and the use of a vacuum device. Results: From January 2014 to March 2016, 15 subjects affected by PD with severe penile curvatures were enrolled in the study. At 6 months after surgery, the IIEF scores for erectile function were not statistically significantly different before and after surgery (p > 0.05); the other items, especially orgasmic function (p = 0.01), sexual desire (p < 0.01), intercourse satisfaction (p = 0.01), and overall satisfaction (p = 0.04), were all statistically significant. The modified EDITS questionnaire reported that 80% of patients were satisfied, that 13.3% were dissatisfied, and that 1 patient (6.6%) was dissatisfied with the surgery. Moreover, there was no statistically significant decrease in the patients’ penile lengths. The aim of this study was to use a rehabilitation protocol consisting of Li-ESWT, the administration of 5 mg/daily, and the use of a vacuum device in order to preserve the erectile function of patients undergoing straightening approaches using surgical grafting. In addition, patient satisfaction following surgery was analyzed.

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Our experience with the management of penile fracture: a single institutional prospective observational study in eighteen patients over a two-year period

International Surgery Journal ◽

10.18203/2349-2902.isj20212712 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2089

Author(s):

Soumish Sengupta ◽

Supriya Basu ◽

Kadambari Ghosh ◽

Subhrajyoti Sengupta

Keyword(s):

Observational Study ◽

Sexual Intercourse ◽

Erectile Function ◽

Prospective Observational Study ◽

Tunica Albuginea ◽

Penile Curvature ◽

Penile Fracture ◽

Fracture Management ◽

History Of ◽

Urological Emergency

Background: Penile fracture is a not an unusual encounter in urological emergency. The condition results from disruption of the tunica albuginea which envelops the corpora cavernosa as a result of any condition which leads to the sudden rise of intra-cavernosal pressure. The study was designed to analyse the clinical spectrum and complication of penile fracture.Methods: This is a prospective observational study undertaken from April, 2019 to March, 2021on 18 patients. The demographic profile of all the patients, aetiology of penile fracture, management strategies and pre-operative sexual functions were documented. Erectile function was evaluated using international index of erectile function (IIEF).Results: Seventeen out of 18 patients (94.44%) gave a history of injury during sexual intercourse. Out of the seventeen patients with history of injury following sexual intercourse, only 9 (52.94%) were married. 15 (93.75%) had disruption of the tunica albuginea in the ventrolateral position with 10 patients (66.66%) on the right side. Patients were followed up in the OPD after 2 weeks and then at 6 month and 1-year intervals. At 12 months postop, none of the patients complained of sexual inactivity. Average time to return to sexual activity was 3.2 months. Two patients complained of penile curvature >20 degree. Six patients complained of penile nodule at the site of repair.Conclusions: Penile fracture is a urological emergency which is primarily diagnosed clinically. Prompt diagnosis and surgical exploration gives good outcome in terms of preservation of sexual function.

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