What is the treatment for penile fracture?

Treatment of Penile Fracture

Prompt surgical exploration and repair is the definitive treatment for penile fracture and must be performed immediately upon presentation to minimize long-term complications including erectile dysfunction and penile curvature. 1

Diagnosis

Clinical presentation alone is typically diagnostic:

• Suspect penile fracture when the patient reports a cracking or snapping sound during intercourse or manipulation, followed by immediate detumescence, accompanied by penile swelling and ecchymosis. 1
• History and physical examination are sufficient for diagnosis in most cases, with no further imaging required. 1, 2
• Penile pain and angulation may also be present. 1

Imaging is reserved for equivocal cases only:

• Ultrasound may be performed when clinical signs are unclear, though it has limitations (sensitivity 66.7% in one series). 1, 3
• MRI can be considered if ultrasound is equivocal. 1
• If imaging remains equivocal or diagnosis is uncertain, proceed directly to surgical exploration. 1

Surgical Treatment

Immediate surgical repair is the standard of care:

• Perform prompt surgical exploration and repair at the time of presentation—this approach is associated with significantly lower rates of erectile dysfunction and penile curvature compared to conservative management. 1
• The repair involves exposing the injured corpus cavernosum through either a ventral midline or circumcision (subcoronal) incision. 1, 2
• Repair the tunical tear with absorbable suture. 1
• Mean hospitalization is 2-3 days. 4

Surgical outcomes are superior to conservative management:

• Conservative treatment results in complications in 80% of cases, including wound infection, painful erection, penile nodule, curvature, and erectile dysfunction. 5
• Surgical repair results in full erection preservation in most patients, with only 10.8% experiencing painful erection as the most common complication. 5
• Even delayed presentations (up to 23 days) can be successfully managed surgically and should always be offered surgical treatment. 6

Evaluation for Urethral Injury

Mandatory evaluation for concomitant urethral injury is required in specific circumstances:

• Evaluate for urethral injury in any patient with penile fracture who presents with blood at the urethral meatus, gross hematuria, or inability to void. 1
• Urethral injury occurs in 10-22% of penile fracture cases. 1
• Bilateral corporal body fracture is an additional risk factor for urethral injury. 1
• Perform either urethroscopy or retrograde urethrogram—neither method is superior, and the choice depends on equipment availability and timing. 1

Common Pitfalls to Avoid

• Do not delay surgical repair: Immediate repair (within hours) provides the best outcomes, though even delayed cases benefit from surgery. 1, 4, 6
• Do not rely solely on ultrasound: Clinical diagnosis is more predictive than ultrasound in determining the site and presence of the tear. 3
• Do not pursue conservative management: This approach has unacceptably high complication rates (80%) compared to surgical repair. 5
• Do not miss urethral injury: Always evaluate for urethral involvement when warning signs are present, as this occurs in up to 22% of cases. 1