What are the signs of a penile fracture?

Signs of Penile Fracture

Penile fracture must be suspected when a patient presents with penile ecchymosis, swelling, cracking or snapping sound during intercourse or manipulation, and immediate detumescence. 1

Classic Signs and Symptoms

The diagnosis of penile fracture is primarily clinical, with several characteristic findings:

• Primary signs (highly suggestive):

  • Penile swelling and ecchymosis ("eggplant deformity") 1, 2
  • History of cracking or snapping sound during the traumatic event 1
  • Immediate detumescence (loss of erection) 1
  • Penile pain 1
  • Penile angulation or deformity 1

• Signs of potential urethral involvement (require additional evaluation):

  • Blood at the urethral meatus 1
  • Gross hematuria 1
  • Inability to void 1, 2
  • Urethrorrhagia (bleeding from urethra) 2

Mechanism of Injury

Penile fracture typically occurs during:

• Sexual intercourse (most common cause) 3
• Masturbation 4
• Direct trauma to the erect penis 5
• Manipulation of the penis during nocturnal tumescence 4

Diagnostic Approach

In most cases (approximately 95%), penile fracture can be diagnosed based on history and physical examination alone when classic symptoms are present 1, 3. However, in equivocal cases:

• Ultrasound is recommended as first-line imaging due to:

  • Wide availability
  • Low cost
  • Rapid examination time 1, 6

• MRI may be considered when ultrasound results are equivocal 1, 6

• Surgical exploration should be performed if imaging remains inconclusive or diagnosis remains in doubt 1

Evaluation for Urethral Injury

Urethral injury occurs in approximately 10-22% of penile fracture cases 6. Evaluation for urethral injury is mandatory when:

• Blood is present at the urethral meatus
• Patient has gross hematuria
• Patient is unable to void
• Bilateral corporal body fracture is present 1

Options for urethral evaluation include:

• Urethroscopy
• Retrograde urethrogram 1

Clinical Pitfalls and Caveats

1. Delayed diagnosis risks complications:

   • Higher rates of erectile dysfunction
   • Penile curvature
   • Painful erections 6

2. Non-surgical management should be avoided as it leads to poorer outcomes 6

3. Bilateral corpus cavernosum ruptures are associated with higher likelihood of urethral injury 1, 2

4. Scrotal hematomas may accompany severe penile fractures and require evacuation 2

5. Immediate surgical intervention provides the best outcomes for erectile function, urination, and future sexual activity 1, 2

Remember that penile fracture is a urological emergency requiring prompt diagnosis and surgical management to prevent long-term complications affecting sexual function and quality of life.