What is the treatment for a fractured penis?

Treatment of Penile Fracture

Prompt surgical exploration and repair is the standard treatment for penile fracture and should be performed in all patients with acute signs and symptoms of penile fracture. 1, 2

Diagnosis

• Clinical presentation typically includes:

  • Penile swelling and ecchymosis
  • Cracking or snapping sound during intercourse or manipulation
  • Immediate detumescence
  • Penile pain and angulation 1

• History and physical examination alone are often diagnostic when classic symptoms are present 1, 2

• For equivocal cases:

  • Ultrasound is recommended as first-line imaging due to wide availability, low cost, and rapid examination time 1, 2
  • MRI may be considered when ultrasound results are equivocal 2
  • If imaging is equivocal or diagnosis remains in doubt, surgical exploration should be performed 1

Evaluation for Urethral Injury

• Must be performed in patients with:

  • Blood at the urethral meatus
  • Gross hematuria
  • Inability to void 1, 2
  • Bilateral corporal body fracture (additional risk factor) 1

• Evaluation options:

  • Urethroscopy
  • Retrograde urethrogram 1, 2
  • Neither method is superior; choice depends on equipment availability and timing 1

Surgical Management

1. Immediate surgical repair:

   • Exposes the injured corpus cavernosum through either:
     • Ventral midline incision, or
     • Circumcision incision 1
   • Tunical repair is performed with absorbable suture 1
   • Should be performed at time of presentation to improve long-term outcomes 1, 2

2. For concomitant urethral injury:

   • Prompt surgical repair
   • Establishment of urinary drainage 2

Outcomes and Complications

• Surgical repair results in significantly better outcomes compared to conservative management:

  • 96% of surgically treated patients maintain adequate erections vs. only 50% with conservative treatment 3
  • Conservative management is associated with higher rates of:
    • Erectile dysfunction
    • Penile curvature
    • Painful erections 2, 3

• Potential complications after surgical repair:

  • Erectile dysfunction (17-20% of cases) 4, 5
  • Penile nodules/fibrous tissue (41-47% of cases) 6, 5
  • Mild penile curvature 7

Follow-up Care

• Regular follow-up is necessary to monitor for complications:

  • Erectile dysfunction
  • Penile curvature
  • Urethral stricture 2

• For cases with urethral injury, urethrography should be performed every two weeks until complete healing 2

Important Caveats

• Delay in treatment significantly increases complication rates 2, 3
• Primary repair should not be undertaken if:
  • Patient is unstable
  • Surgeon lacks expertise in urethral surgery
  • There is extensive tissue destruction or loss 1
• Excessive debridement should be avoided as genital skin is well-vascularized 2