Fracture of penis: Controversy of surgical versus conservative treatment

doi:10.1016/0090-4295(84)90380-7

Urology

Volume 24, Issue 1, July 1984, Pages 21-24

https://doi.org/10.1016/0090-4295(84)90380-7 Get rights and content

Abstract

Fracture of the penis is rare. Ninety-three cases are reported in the English literature up to December, 1981. Review of the literature after March, 1971, reveals 35 cases, including 3 cases of the authors. The complication rate of conservative treatment before and after 1971 was 10 per cent and 53 per cent, respectively, including deformity of the penis, pulsatile diverticulum, decrease in turgidity, and failure of conservative treatment. Early surgical treatment is strongly recommended because of the excellent results, shorter hospitalization, less morbidity, and early return to full sexual activity. The incidence of associated urethral injury before and after 1971 is 33 per cent and 14 per cent, respectively.

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Cited by (89)

Urethrography for diagnostic of penile fracture with ruptured anterior urethra and right corpus cavernosum
2022, Radiology Case Reports
Penile fracture is a rare urological emergency that effect due to blunt trauma on erect penis. Mostly often occurs during sexual intercourse and is rare in blunt of trauma from impact at penile. That trauma it can caused by rupture and hematoma of tunica albuginea. In physical examination, we found swelling and hematoma of penile shaft, with abnormal angulation to the right and tenderness. Two hours after sexual intercourse, patient urinated and he felt fresh blood comes out with urine and it is painful. Penile fracture can be diagnostic with clinically and imaging radiology. Important information due clinically with précising radiologist finding can making the correct diagnosis and surgical procedure can be done immediately.
Impact of Surgical Treatment of Penile Fracture on Sexual Function
2019, Urology
To conduct a comprehensive assessment of sexual function of patients undergoing surgical treatment of penile fracture (PF), covering psychological aspects related to trauma.
Patients undergoing surgical treatment of PF from January 2014 to August 2017 were followed-up in our department for at least 6 months. The patients underwent a detailed clinical follow-up, including physical examination and were interviewed about any evidence of erectile dysfunction, penile nodules, or curvature acquired after surgery, besides psychological sexual problems.
A total of 58 patients conducted the follow-up. The mean age was 38.5 years (range: 18-66 years). Eight (13.7%) patients complained of penile curvature after surgery. Postoperative erectile function was recovered after 6 months in 50 (86.2%) cases. After the last evaluation at 18 months, only 1 patient developed persistent erectile dysfunction (ED) and color duplex Doppler ultrasound excluded a vascular etiology. Psycho-sexual evaluations showed that 45 (77.5%) patients feared a new episode of PF. Changes in sexual habits, such as avoiding vigorous sexual intercourse, was reported by 40 (68.9%) patients. Finally, patients with performance anxiety and those who reported a negative impact on sexual life were more susceptible to the development of ED (P = .0337 and P = .0418, respectively).
Sexual complications after surgical treatment of PF are unusual but may occur in the late postoperative period and should be treated. Psychological sequela is very common, causing fear of recurrence and psychogenic ED, resulting in negative impact on the sexual life of these patients, which should be monitored closely.
Results of SMSNA Survey Regarding Complications Following Intralesional Injection Therapy With Collagenase Clostridium Histolyticum for Peyronie's Disease
2016, Journal of Sexual Medicine
Citation Excerpt :
For non–CCH-related corporal fractures, the general consensus recommends immediate surgical repair.10,11 The impetus to operate is based on the knowledge that conservative management is associated with higher rates of postoperative ED, de novo penile curvatures, and abscess formation.11–13 There is, however, debate among experts as to whether CCH-induced corporal ruptures in PD patients need to be similarly addressed.
Intralesional injection of collagenase clostridium histolyticum (CCH) for Peyronie’s disease (PD) can result in serious adverse events such as hematoma formation and corporal rupture.
To investigate the prevalence of complications from CCH and management trends among CCH prescribers.
A survey was sent to all 693 members of the Sexual Medicine Society of North America (SMSNA) with valid email addresses. Responders were asked to participate if they were prescribers of CCH. Data regarding prescriber experience with CCH, procedural preferences, and rates and management strategies of complications were collected.
One hundred SMSNA members completed the survey, with 36%, 23%, and 41% of responders having performed ≤10, 10 to 20, and >20 CCH injections, respectively.
Of the responders, 94% reported hematomas in <25% of patients, with 63% preferring to observe and 37% treated with a combination of observation, application of a compressive dressing, and/or drainage of the hematoma. Corporal ruptures were encountered by 34% of physicians at a median of 5 days (0.5 to 30 days) from the last CCH injection. Rupture was located over the treated plaque in 84% of cases, and surgical intervention was the preferred management option by 67% of members. A distal circumcising degloving incision was used in 76% of cases, and 62% of responders reported the quality of tissue to be worse than would be expected with a non-CCH penile fracture. There were no significant differences in erectile function, ability to have intercourse, change in penile curvature, and patient satisfaction among patients who underwent surveillance vs surgery. One observed patient developed a penile abscess.
A wide variation exists among SMSNA members’ strategies to prevent and manage complications of CCH. One in 3 prescribers reported encountering a corporal rupture during CCH therapy, and it is currently undetermined if there is a benefit of surgery vs conservative management.
Does timing of presentation of penile fracture affect outcome of surgical intervention?
2011, Urology
Citation Excerpt :
In our series, sexual intercourse was the prime cause of trauma in both groups, similar to that reported in Western countries.6,15 In the past, conservative treatment in the form of ice packs and antiinflammatory medicines were regarded as the standard treatment for penile fractures.17,18 However, such an approach was associated with a high incidence of complications such as curvature, palpable nodule, and erectile dysfunction in up to 50% of patients,1 in addition to prolonged recovery and possible hematoma infection.
To assess the effect of timing of presentation of cases with penile fracture on the outcome of surgical intervention.
Between January 1986 and May 2010, 180 patients with penile fracture were treated surgically in our center. To assess the effect of timing of presentation, patients were classified into 2 groups: group I with early presentation (≤24 hours) and group II with delayed presentation (>24 hours). All patients were contacted by mail or phone and were re-evaluated. All patients were reevaluated by questionnaire and local examination. Patients with erectile dysfunction were evaluated by color Doppler ultrasonography.
Group I included 149 patients (82.8%) and group II included 31 (17.2%). In group I, patients presented to the emergency department from 1-24 hours (mean, 11.8) after occurrence of the penile trauma. Although patients in group II presented from 30 hours to 7 days (mean, 44.7 hours). Both groups were similar regarding etiology of injury, clinical presentation, surgical findings, and incidence of associated urethral injury. Mean follow-up period for group I was 105 months, and for group II it was 113 months. After such long-term follow up, 35 (19.4%) patients had complications; however, there was no statistically significant difference between both groups.
Cases of penile fracture with early or delayed presentation up to 7 days should be managed surgically. Both groups have comparable excellent outcome with no serious long-term complications.
Fractured penis: Diagnosis and management
2009, Journal of Sexual Medicine
Penile fracture is a well‐recognized clinical entity. It is relatively uncommon and is considered a urological emergency. Its management has been a subject of controversy.
In this article, we will review contemporary knowledge of the epidemiology, pathophysiology, evaluation, and evolving management strategies of penile fracture.
A case report was discussed followed by an English‐language Medline review.
Review of the available literature to establish best‐practice management.
The injury is defined as the traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. The condition is underreported. The commonest causes were coital injuries and penile manipulation. The diagnosis was usually fairly straightforward because of the stereotypical clinical presentation. Associated injuries included urethral rupture. Imaging was helpful in selected cases. Conservative measures were associated with increased complications. Most authors advocated early surgical repair. False explorations have been reported.
Penile fracture is a clinical diagnosis. The ideal management has evolved and remains largely surgical. Preoperative imaging should not delay surgical repair. Al‐Shaiji TF, Amann J, and Brock GB. Fractured penis: Diagnosis and management. J Sex Med 2009;6:3231–3240.
Effect of Cyanoacrylic Glue on Penile Fracture: An Experimental Study
2008, Journal of Urology
Citation Excerpt :
Rupture of the tunica albuginea is usually unilateral and transverse.12 There is some controversy about the treatment approach to traumatic rupture of the penis.4 In earlier studies conservative treatment was recommended, using pressure dressings over a Foley catheter, ice packs initially and hot packs later, and penoscrotal suspension associated with antibiotics and anti-inflammatory drugs.3
We investigated the effect of Glubran®2 cyanoacrylic glue on rat cavernous tissue after forming penile fractures experimentally as well as the histopathological effect. We also investigated its clinical use.
Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to 4 main groups of 8 each. In the control group the incision was not repaired and it was left to secondary healing. In the glue group cyanoacrylic glue was only applied to the incision region. In the primary repair group the incision was primarily repaired and in the final group cyanoacrylic glue was applied to the incision region following primary repair. Three weeks later penectomy materials were examined histopathologically.
When the control group was compared with the other groups, the differences in cavernous tissue healing with fibrosis and hyperemia-bleeding were statistically significant (p = 0.043 and 0.003, respectively). In the glue group fibrosis was observed in 2 rats. This group was the best according to cavernous healing. Although there was no significant difference between the control group and the other groups according to inflammation (p = 0.057), the glue group was better than the primary repair group (p = 0.026). No significant inflammation or hyperemia-bleeding was observed in the glue group. When the experimental groups were evaluated for histopathological parameters, it was observed that the best results were obtained in the glue group.
Cyanoacrylic glue can be used in cavernous surgery due to its hemostatic, adhesive and anti-inflammatory properties.

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Scientific articleFracture of penis: Controversy of surgical versus conservative treatment

Abstract

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

Ann Emerg Med

J Urol

J Urol

Fracture of the penis

Int Surg

Fracture of the penis

Br J Urol

Scientific article
Fracture of penis: Controversy of surgical versus conservative treatment