Penile fractures: the successful outcome of immediate surgical intervention

The data of 60 patients admitted to Mansoura Urology and Nephrology Center with penile fractures and treated by immediate surgical repair were reviewed with respect to their presentation, investigations, operative and post-operative details. Forty-nine patients were followed up regarding penile curvatures, plaques and erectile function. Patients reporting decreased erectile function were further assessed by evaluating their response to intracavernous injection of PGE1 and by penile color duplex Doppler ultrasonography. All of our patients had the classic clinical presentation of penile swelling and ecchymosis. Only five patients had accompanying urethral rupture. Penile ultrasonography was used to confirm the diagnosis in 23 patients. Immediate exploration was done using subcoronal circumferential incision in about two-thirds of the cases. All tunica albuginea ruptures were unilateral except one case which was bilateral. Interrupted absorbable sutures were used for repair in most of the patients. Urethral repair was done in five cases. Delayed complications were detected in only six cases (12.2%) in the form of mild penile curvature on erection, plaques and/or mild erectile dysfunction. Intracavernous injection (ICI) of PGE1 and penile duplex Doppler showed a normal pattern in three patients with erectile dysfunction while the fourth showed incompetent veno-occlusive mechanism. Psychosexual consultation was required for two of these patients while the third was successfully managed by self-ICI of PGE1. We conclude that the excellent outcome of our patients parallels other reports of early surgical repair regarding low morbidity, short hospital stay and rapid functional recovery. There is a low incidence and degree of erectile dysfunction among repaired patients; however, it should be thoroughly investigated and properly managed. Ultrasonography is easy and helpful; however, the more invasive cavernosography and/or magnetic resonance imaging are indicated when the case is atypical, or the diagnosis of rupture of tunica is suspicious.