Approach to management of penile fracture- Our Three-year experience at a Teaching Hospital

Introduction: Penile fracture is a rare surgical emergency. It usually occurs as a single rupture of the tunica albuginea in one of the two corpora cavernosa; a rupture of both masses is an uncommon finding. We conducted this study to determine the etiology, clinical presentation and to review the causes and management of penile fracture. Methods: The retrospective study was carried out on 17 patients, admitted in the department of Urosurgery from January 2017 to December 2020 with penile fracture in a tertiary care teaching hospital in Kathmandu. Patient demographic profile, etiology, clinical presentation, time interval from injury to presentation, investigation done, treatment given and intraoperative findings were analyzed. Results: The main cause of penile fractures was sexual intercourse (82.35%) followed by manual manipulation (17.65%). Crackling sound (100%) followed by penile hematoma and pain were the most common presenting symptoms among the patients. Surgical exploration and repair of injury was done in all patients. Conclusion: Most of the time diagnosis of penile fracture can be made reliably by history and physical examination. Early surgical intervention is associated with a good outcome, regardless of the timing of presentation.

​​The Effect of Platelet Rich Plasma on Wound Healing in the Repair of Experimental Penile Fractures

Background: Penile fractures are caused by the rupture of the tunica albuginea and the underlying layers of corpus cavernosum as a result of the exposure of the erect penis to blunt trauma. Although conservative treatment methods have been recommended in former studies, recent studies favor early surgical options. Platelet-rich plasma (PRP) is a blood product rich in cytokines and several growth factors, obtained from the patient’s own blood commonly used to stimulate healing in acute and chronic wound treatments. The efficiency of homologous PRP treatment in rats with penile fractures have been assessed in terms of clinical manifestation and histopathological findings in the present study. Methods: Thirty-five rats were randomly divided into five groups, each containing seven rats as follows: 1. Conservative group: Following the formation of penile fracture, medical interventions were not initiated on fracture area and the wound was left for secondary healing. 2. Bandage group: Following the formation of penile fracture, self-adherent elastic bandage (3M Coban) was applied to the fracture area for three days. 3. Primary repair group: Following the formation of a penile fracture, the lacerated area was repaired with 7/0 vicryl primary sutures. 4. Primary repair + Homologous Platelet Rich Plasma group: Before the operation, 10 cc of blood was taken from one rat under general anesthesia by intracardiac puncture and PRP material was prepared from this blood. Homologous PRP was topically administered on the wound in the fracture area and then the penile fracture was repaired with 7/0 vicryl as simple separate stitches. 5. Non-operative control group: Surgical procedures were not applied to this group; it was used as the control group. Result: The effect of the PRP treatments on the surgical repair options in the rats with penile fractures was investigated. The present findings revealed that following the repair with conservative treatments, the fracture format persisted and various complications like infection, oedema, excessive fibrosis and hyperemia were encountered. On the other hand, the best healing was achieved in primary repair + PRP group in terms of clinical manifestation and histopathological findings.

Delayed Presentation of a Penile Fracture: A Case Report

Penile fracture is a urological emergency caused by blunt trauma to an erect penis. We report a case of a 40-year-old male who presented with a complaint of a painful swelling of the penis for 4 days. On examination, a flaccid swollen tender penis with bluish discoloration over the shaft and scrotum was noted. A clinical diagnosis of delayed penile fracture was made which was managed immediately surgically under spinal anesthesia. Ourreport emphasizes that penile fracture is diagnosed solely on a reliable history and clinical examination. It has outstanding outcome despite delayed presentation if treated promptly.