Penile fracture: differential diagnosis, management and outcome

To determine the value of a diagnostic and therapeutic approach for patients presenting with acute penis and the effects of this management on the outcome.

The study comprises 21 consecutive patients (mean age 33.3 years, range 19-53) who presented with acute penis (acute pain and swelling during and soon after intercourse). The mean interval between the accident and the treatment was 6 h (range 2-20). All patients initially underwent cavernosography, followed by surgical exploration.

Cavernosography showed extravasation of the contrast medium, indicating a corporal tear, in 19 of 21 patients. Surgical exploration revealed rupture of the deep dorsal vein in two patients whose radiological examinations were normal. In the remaining 19 patients, corporeal tears were repaired. The mean follow-up was 26.7 months; all patients regained penile function (potency). Penile curvature was the only adverse effect in three of the 21 patients, all of whom presented for medical treatment relatively late after the initial accident.

In the management of the acute penis, cavernosography should be performed first and the treatment policy should be determined from the radiological findings. Conservative therapy should be chosen only when the corporeal bodies are intact.