Functional, Sexual and Psychosexual Outcomes After Penile Fracture Repair: A Scoping Review

Area of Science:

• Urology
• Sexual Medicine
• Trauma Surgery

Background:

• Penile fracture, a rupture of the tunica albuginea, is a urological emergency often caused by sexual activity or blunt trauma.
• While surgical repair is preferred over conservative management due to high complication rates (e.g., erectile dysfunction, penile curvature), long-term psychosexual outcomes are poorly understood.

Purpose of the Study:

• To map and synthesize evidence on functional, sexual, and psychosexual outcomes following surgical penile fracture repair.
• To examine the impact of surgical timing on erectile function and identify risk factors for postoperative erectile dysfunction.
• To evaluate the psychological effects on sexual satisfaction, relationships, and ejaculatory function.

Main Methods:

• A scoping review adhering to the PRISMA-ScR framework.
• Searches conducted across major databases (PubMed/MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web of Science).
• Data extraction included demographics, injury details, surgical timing, and validated psychometric assessments from nine studies.

Main Results:

• Immediate surgical repair (within 24 hours) is associated with significantly lower rates of postoperative erectile dysfunction (6.5–16.5%) compared to delayed surgery (up to 42.9%) or conservative management (up to 52.9%).
• Independent risk factors for poor outcomes include age >50, urethral injury, bilateral corporal involvement, and large tunical defects (>2 cm).
• While erectile function is often preserved, psychosexual issues are prevalent, with up to 77.5% reporting fear of recurrence and 69% altering sexual habits; psychological distress is specific to sexual performance and relationships.

Conclusions:

• Immediate surgical intervention is the gold standard for penile fracture, improving functional and anatomical outcomes.
• Postoperative assessment must extend beyond hemodynamic measures to include psychosexual well-being.
• Further research is needed to establish optimal multidisciplinary follow-up and rehabilitation strategies, including psychological and partner-centred care, to address persistent psychosexual sequelae.