What is the treatment for a penile fracture?

Treatment for Penile Fracture

Prompt surgical exploration and repair is the standard of care for patients with penile fracture and should be performed as soon as possible to improve long-term outcomes. 1, 2

Diagnosis and Initial Assessment

• Suspect penile fracture when a patient presents with:

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

• History and physical examination are often sufficient for diagnosis when classic symptoms are present 1, 2

• For equivocal cases, consider:

  • Ultrasound as first-line imaging (widely available, low cost, rapid) 1, 2
  • MRI if ultrasound results are inconclusive 1
  • If imaging remains equivocal, proceed with surgical exploration 1

• Evaluate for concomitant urethral injury if patient has:

  • Blood at the urethral meatus
  • Gross hematuria
  • Inability to void
  • Bilateral corporal body fracture 1, 2

Surgical Management

Timing and Approach

• Immediate surgical intervention is strongly recommended to prevent complications such as erectile dysfunction, penile curvature, and painful erections 1, 2
• Delayed presentation cases should still be offered surgical treatment, as evidenced by successful outcomes even with presentations as late as 23 days 3

Surgical Technique

1. Expose the injured corpus cavernosum through:

   • Ventral midline incision, or
   • Circumcision incision with penile degloving 1, 4

2. Identify, debride, and perform primary repair of the tear in the tunica albuginea 1, 5

3. Use absorbable suture for tunical repair 1

4. If concomitant urethral injury is present, perform appropriate repair during the same procedure 1, 2

Post-Operative Care and Follow-Up

• Monitor for complications:

  • Wound infection
  • Erectile dysfunction
  • Penile curvature
  • Painful erections 5, 4, 6

• Regular follow-up is necessary to assess:

  • Erectile function (can be evaluated using the International Index of Erectile Function)
  • Development of penile curvature or nodules
  • Pain during erection or intercourse 2, 6

Outcomes and Prognosis

• Early surgical intervention results in excellent outcomes with minimal complications 5, 4, 6
• Mean hospitalization time is typically short (1-3 days) 5, 6
• Most patients regain full erectile function with prompt surgical repair 5, 4

Pitfalls and Caveats

• Do not delay surgical intervention - conservative management is associated with higher rates of complications 2
• Do not miss concomitant urethral injuries - perform appropriate evaluation when indicated 1, 2
• Do not perform excessive debridement - genital skin is well-vascularized and tissues with marginal viability may survive 2
• Do not neglect follow-up - complications may develop over time and require additional intervention 2

Surgical repair of penile fracture, even in delayed presentations, offers the best outcomes for preserving erectile function and preventing long-term complications such as penile curvature and painful erections 1, 2, 3, 6.