Intraoperative Ultrasound-Guided Repair of Penile Fracture: A Case Report

Penile fracture is a rare urological emergency resulting from rupture of the tunica albuginea during blunt trauma to an erect penis, typically during sexual intercourse. While immediate surgical repair is associated with superior outcomes compared with conservative management, delayed treatment can lead to significant long-term complications including penile curvature in 30% of cases and erectile dysfunction in 50%-62% of cases. We present the case of a 22-year-old patient who sustained a penile fracture while manipulating his erect penis. Clinical examination revealed penile swelling, bruising, and a 60° leftward curvature. Intraoperative ultrasound (IO-USG) with a linear probe precisely localized a tunica albuginea defect in the right corpus cavernosum, enabling a minimally invasive 1.5-cm transverse incision directly over the fracture site. This approach avoided complete penile degloving, reduced operative time and blood loss, and facilitated complete clot evacuation and defect closure using interrupted 3-0 PDS sutures. Postoperative recovery was uneventful, with the patient discharged the following day and reporting normal erectile function and no penile deformity at the 3-month follow-up. A literature review confirms that while preoperative imaging is commonly utilized for surgical planning, IO-USG guidance for real-time fracture localization and incision placement remains rarely reported. Although MRI and CT offer superior soft tissue resolution, they are limited by availability, time constraints, and radiation exposure. IO-USG is readily accessible and noninvasive; although operator-dependent, it provides high-resolution real-time guidance that enables smaller incisions, minimizes postoperative complications such as glans numbness, and optimizes functional outcomes. We conclude that IO-USG-guided repair of penile fracture facilitates rapid identification of the injury site, accurate assessment of hematoma burden, and targeted surgical approach that avoids penile degloving while ensuring complete repair.