Management of Penile Fracture in the Emergency Department
This patient requires emergent urology consultation for immediate surgical exploration and repair of the tunica albuginea tear. 1, 2
Immediate ED Management
The correct answer is C: emergent urology consultation. This patient has a confirmed penile fracture (tunica albuginea tear) on ultrasound, which mandates prompt surgical intervention. 1, 2
Why Surgical Exploration is Essential
Surgical exploration and repair is associated with significantly lower rates of erectile dysfunction and penile curvature compared to conservative management. 1, 2
The AUA guidelines explicitly state that surgical exploration and repair should be performed promptly—ideally within hours of presentation—to optimize long-term functional outcomes. 2
Conservative management carries a 29% complication rate with prolonged hospitalization (mean 14 days), while immediate surgical repair results in preservation of normal erectile function with brief hospital stays (mean 3.8 days). 3
Why Other Options Are Incorrect
AP pelvis x-ray (Option A) has no role in penile fracture management, as this is a soft tissue injury requiring surgical repair, not a bony injury. 1
Compressive dressing (Option B) represents conservative management, which is outdated and associated with higher complication rates including erectile dysfunction, penile curvature, and tunical scar formation. 1, 2, 3
Evacuation of subcutaneous hematoma (Option D) is insufficient—the underlying tunica albuginea tear must be surgically repaired with absorbable sutures to prevent complications. 1, 2, 3
Critical Clinical Considerations
Urethral Injury Assessment
Although this patient's ultrasound shows no urethral disruption, remain vigilant as urethral injury occurs in 10-22% of penile fracture cases. 1, 2
The absence of blood at the urethral meatus, gross hematuria, or inability to void makes concomitant urethral injury unlikely in this case. 2
If any of these signs were present, urethroscopy or retrograde urethrogram would be required before surgical repair. 2
Timing of Surgical Intervention
Immediate repair (within hours) provides the best outcomes, though even delayed presentations benefit from surgical intervention rather than conservative management. 2, 4
The surgical approach involves circumferential subcoronal incision, penile degloving, identification of the tunica albuginea tear, sharp débridement, and primary repair with absorbable sutures. 1, 3
Common Pitfalls to Avoid
Do not delay surgical consultation or attempt conservative management—this outdated approach leads to worse functional outcomes. 1, 2, 3
Do not miss bilateral corporal involvement, which increases the risk of urethral injury and may require more extensive repair. 2
Do not discharge the patient for outpatient follow-up—this is a true urological emergency requiring same-day surgical intervention. 1, 2