Penile Fracture: Symptoms, Treatment, Cases

In this video we can see a penile fracture – a relatively uncommon trauma, caused by nonphysiological bending of the penile shaft. It is accompanied by rupture of tunica albuginea and the tumescent corpora cavernosa, with or without rupture of urethra and the deep dorsal vein.

Typically, patients report sharp pain and cracking sound, with consecutive loss of erection, deformity and discoloration. Penile deformity, swelling and discoloration due to leakage of the blood from corpus cavernosum, are visible.

Urethral injury is associated in 10-30% of cases of penile fracture. It can manifest by the appearance of blood at the urethral meatus or in urine, as well as dysuria and urinary retention. Injury of the urethra can also remain unrecognized as being asymptomatic.
Consequent urethral injury or rupture of corpus spongiosum must precisely be assessed and repaired.

Rupture of the deep dorsal vein has similar manifestations as penile fracture, and surgical exploration is necessary to differentiate. Swelling and ecchymosis are present, without typical crack or popping sound, and without rapid development of detumescence.

Conservative treatment was considered as treatment of choice in the past. It includes cold compresses, pressure dressing, and administration of anti-inflammatory drugs, fibrinolytics, anti-androgens and sedatives. It results in complications in 29-53% of penile fracture cases. The most common complications of conservative treatment are missed urethral injury, penile abscess, permanent curvature, presence of the nodule formation at the site of the fracture, fistulas, as well as painful erection and erectile dysfunction.

Immediate surgical repair in case of penile fracture is required. The aim of surgical correction is penile restoration in preinjury state, prevention of penile deformities and erectile dysfunction, maintenance of penile length and retrieving of normal voiding.