Successful Delayed Repair of a Penile Fracture due to COVID-19 Infection

Penile fracture is a rare condition characterised by disruption of the tunica albuginea typically caused by blunt trauma to a tumescent penis. It is a urological emergency that requires prompt diagnosis with a view to urgent treatment. The current global consensus on management of penile fractures is urgent surgical exploration and repair of the tunical defect. This is recommended with a view to minimise the risk of long-term functional outcomes, mostly relating to sexual dysfunction. However, the lack of high quality data on 'immediate' versus 'delayed' surgical repair groups in terms of long-term outcomes means that the exact timing of surgical repair is still debatable.

A 50-year-old healthy sexually active male presented after a snapping sound during sexual intercourse 90 minutes before, followed by detumescence and penile pain. A tunical breach in the left proximal penile shaft was diagnosed clinically and confirmed on emergency ultrasound. The patient tested positive for COVID-19 and, given the perioperative risk of morbidity and mortality, it was decided to delay surgical repair. 10 days after the injury, following a negative COVID-19 test, he successfully underwent circumferential degloving, circumcision and closure of the tunical defect. Upon review at 4 and 20 months post-op, there was no scarring or penile curvature, and he was having normal painless erections and penetrative sexual intercourse.

This is a case of early presentation of penile fracture in a healthy sexually active male, where surgical repair was delayed by 10 days because of COVID-19 infection, with positive short and medium term outcomes. It reinforces the idea that penile fracture patients who present late should still be offered surgery and that delaying surgery to optimise a patient's condition may be an acceptable approach. However, more research is needed into timing of surgical repair and its effect on long-term functional outcomes.