From the Guidelines
Immediate surgical repair is the recommended management for penile fracture. The patient should be taken to the operating room as soon as possible for exploration and repair of the tunica albuginea tear, as prompt surgical exploration and repair in patients with acute signs and symptoms of penile fracture is a standard practice, according to the American Urological Association guideline 1.
Key Considerations
- The repair is performed by exposing the injured corpus cavernosum through either a ventral midline or circumcision incision, and tunical repair is performed with absorbable suture, as stated in the guideline 1.
- Surgical repair should be performed at the time of presentation to improve long-term patient outcomes, reducing the risk of complications such as penile deformity, erectile dysfunction, and painful erections.
- Preoperative antibiotics should be administered, and postoperative care includes penile wrapping, urinary catheterization for 24-48 hours, pain management, and abstinence from sexual activity for 6-8 weeks.
Rationale
The urgency for surgery is based on the mechanism of injury, which typically occurs during sexual activity or manipulation of an erect penis, resulting in a characteristic "popping" sound, immediate detumescence, pain, swelling, and bruising. Conservative management with ice, compression, anti-inflammatory medications, and sexual abstinence is no longer recommended as the first-line approach due to higher complication rates. Surgical repair leads to better outcomes with faster recovery, less penile curvature, and lower rates of erectile dysfunction, as supported by the guideline statement from the American Urological Association 1.
From the Research
Penile Fracture Management
The management of penile fracture is primarily focused on surgical repair to minimize complications and ensure optimal recovery of erectile function.
- Immediate surgical repair is widely accepted as the therapy of choice in penile fracture, as it leads to the fastest recovery in erectile function and positive cosmetic outcomes 2, 3.
- The surgical approach typically involves complete evacuation of the hematoma and repair of the tear in the tunica albuginea 2.
- Immediate penile exploration and tunica repair have been the mainstay approach of management, with experts demonstrating that it yields excellent results and is superior to nonoperative treatment in the management of penile fracture 3, 4.
Delayed Presentation
In cases of delayed presentation, surgical repair can still be effective, even after conservative treatment 5.
- A study found that delayed surgical repair of penile fracture under local anesthesia can be an effective method for patients with delayed presentation devoid of urethral involvement 5.
- Another case report highlighted the success of delayed surgical repair, emphasizing that there are no "lost" cases and surgical treatment should always be offered to penile fracture, independently of delayed presentation 6.
Comparison of Surgical and Conservative Treatment
Comparative studies have shown that immediate surgery yields excellent results and is superior to nonoperative treatment in the management of penile fracture 4.
- However, conservative therapy restricted to uncomplicated cases can lead to an equally good outcome, although poor outcomes were more common in the conservative group 4.