Radiological evaluation and our surgical experience in patients with penile fracture

Aim: We aimed to investigate the clinical features, diagnostic methods and surgical methods and results of patients who presentedwith penile fractures.Material and Methods: The data of 18 patients who underwent surgical treatment between December 2008 and 2018 in our clinicwere evaluated retrospectively. Age and etiologic factors were evaluated. Following physical examination, all patients underwentsuperficial penile ultrasonography in the radiology clinic. Ultrasonically, length, location and side of the rupture were determined.The patients were questioned by the postoperative IIEF-5 questionnaire. Pre and post-operative complications were evaluated inpatients. Postoperative erectile functions were evaluated.Results: The mean age was 39.22 ± 14.47 (19-67). The time to contact the emergency department was 4.33 ± 1.97 hours (2-8 hours).In the history of the patients, the causes of the penile fracture included the forceful manipulation of the penis in 5 patients (27.8%),rolling over in the bed while sleeping in 5 patients (27.8%), sexual intercourse in 6 patients (33.3%) and masturbation in 2 patients(11.1%). Mean rupture in tunica albuginea was 12.66 ± 3.06 mm (8-20mm). While 11 (61.1%) of the defects were detected in the rightcorpus spongiosum, 7 (38.9%) were detected in the left corpus spongiosum. The tunica albuginea defect was located in the distalpenile in 14 patients (77.8%), in the midpenil in 3 patients (16.7%) and in the proximal penile in 1 patient (5.5%). The mean hospitalstay was 3 ± 0.90 days (2-5 days). Postoperative the IIEF-5 score was 26.05 ± 1.55 (23-29).Conclusion: Penile fracture is a rare urologic emergency that can be diagnosed clinically. Radiological imaging may be required insuspected cases. Early surgical treatment provides successful results in terms of functional, cosmetic and erectile functions.

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1. Cooper BL, Beres KP. Penile Fracture. J Emerg Med 2017;52:238-9.
2. Meenakshi-Sundaram B, Coco CT, Furr JR, et al. Penile Fracture Following a Fall in a 7-Year-Old Male. Urology 2017;106:200-2.
3. Beilan JA, Wallen JJ, Baumgarten AS, et al. Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture. Sex Med Rev 2018;6:272-8.
4. Ozorak A, Hoscan MB, Oksay T, et al. Management and outcomes of penile fracture: 10 years’ experience from a tertiary care center. Int Urol Nephrol 2014;46:519-22.
5. Asgari MA, Hossieni SY, Safarinejad MR, et al. Penile fracture: evaluation, therapeutic approaches and long term results. J Urol 1996;155:148-9.
6. Godec CJ, Reiser R, Logush AZ. The erect penis-injury prone organ. J Trauma 1988;28:124-6. 7. Gross M, Arnold TL, Waterhouse K. Fracture of the penis: rationale of surgical management. J Urol 1971;106:708-10.
8. 8. Jallu A, Wani NA, Rashid PA. Fracture of the penis. J Urol 1980;123:285-6.
9. Gross M, Arnold TL, Peters P. Fracture of the penis with associated laceration of the urethra. J Urol 1977;117:725-7.
10. Barros R, Lacerda G, Schul A, et al. Sexual complications of penile frature in men who have sex with men. Int Braz J Urol 2018;44:550-4.
11. Mazaris EM, Livadas K, Chalikopoulos D, et al. Penile fractures: immediate surgical approach with a midline ventral incision. BJU Int 2009;104:520-3.
12. Lynch TH, Martínez-Piñeiro L, Plas E, et al. EAU guidelines on urological trauma. Eur Urol 2005;47:1-15.
13. Pruthi RS, Petrus CD, Nidess R, et al. Penile fracture of the proximal corporeal body. J Urol 2000;164:447-8.
14. De Luca F, Garaffa G, Falcone M, et al. Functional outcomes following immediate repair of penile fracture: a tertiary referral center experience with 76 consecutive patients. Scand J Urol 2017;51:170-5.
15. Penson DF, Seftel AD, Krane RJ, et al. The hemodynamic pathophysiology of impotence following blunt trauma to the erect penis. J Urol 1992;148:1171-80.
16. Raheem AA, El-Tatawy H, Eissa A, et al Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption. Arch Ital Urol Andro. 2014;86:15-9.
17. García Gómez B, Romero J, Villacampa F, et al. Early treatment of penile fractures: our experience. Arch Esp Urol 2012;65:684-8.
18. Al-Shaiji TF, Amann J, Brock GB. Fractured penis: diagnosis and management. J Sex Med 2009;6:3231-40.
19. Singh G, Capolicchio JP. Adolescent with penile fracture and complete urethral transection. J Pediatr Urol 2005;1:373-6.
20. Sawh SL, O’Leary MP, Ferreira MD, et al. Fractured penis: a review. Int J Impot Res 2008;20:366-9.
21. Agarwal MM, Singh SK, Sharma DK, et al. Fracture of the penis: a radiological or clinical diagnosis? A case series and literature review. Can J Urol 2009;16:4568-75.
22. Basal S, Yildirim I, Tahmaz L, et al. Penile fracture associated with partial urethral injury: the report of two cases. Turk J Urol 2009;35:374-7.
23. Barros R, Schul A, Ornellas P, et al. Impact of Surgical Treatment of Penile Fracture on Sexual Function. Urology 2018; S0090-4295:31356-6.
24. Bolat MS, Ozen M, Onem K, et al. Effects of penile fracture and its surgical treatment on psychosocial and sexual function. Int J Impot Res 2017;29:244-9.
25. Muentener M, Suter S, Hauri D, et al. Long-term experience with surgical and conservative treatment of penile fracture. J Urol 2004;172:576-9.
26. Yamacake KG, Tavares A, Padovani GP, et al. Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis. Korean J Urol 2013;54:472-6.
27. Falcone M, Garaffa G, Castiglione F, et al. Current Management of Penile Fracture: An Up-to-Date Systematic Review. Sex Med Rev. 2018;6:253-60.
28. Seftel AD, Haas CA, Vafa A, et al. Inguinal scrotal incision for penile fracture. J Uro. 1998;159:182-4.