Penile fracture: outcomes of early surgical intervention.
Daniel E W Swanson, A Scott Polackwich, Brian T Helfand, Puneet Masson, James Hwong, Daniel D Dugi, Ann C Martinez Acevedo, Jason C Hedges, Kevin T McVary
Author Information
Daniel E W Swanson: Department of Urology, Oregon Health & Science University, Portland, OR.
A Scott Polackwich: Department of Urology, Oregon Health & Science University, Portland, OR.
Brian T Helfand: Division of Urology, Department of Surgery, NorthShore University Health, Glenview, IL.
Puneet Masson: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
James Hwong: Department of Urology, Brigham and Woman's Hospital, Boston, MA.
Daniel D Dugi: Department of Urology, Oregon Health & Science University, Portland, OR.
Ann C Martinez Acevedo: Department of Urology, Oregon Health & Science University, Portland, OR.
Jason C Hedges: Department of Urology, Oregon Health & Science University, Portland, OR. Electronic address: hedgesja@ohsu.edu.
Kevin T McVary: Division of Urology, Southern Illinois University of Medicine, Springfield, IL.
OBJECTIVE: To report a series of penile fractures, describing preoperative evaluation, surgical repair, and long-term outcomes. PATIENTS AND METHODS: Medical records from Northwestern Memorial Hospital and Oregon Health & Science University from 2002 to 2011 were reviewed. Clinical presentation, preoperative evaluation, time from injury, mechanism and site of injury, and presence of urethral injury were assessed. Outcomes including erectile dysfunction, penile curvature, and voiding symptoms were evaluated using International Prostate Symptom Score and International Index of Erectile Function scores. RESULTS: Twenty-nine patients with 30 separate episodes of penile fractures presenting to the emergency room were identified. Mean patient age was 43 ± 9.6 years. The time from presentation to the initiation of surgery was 5.5 ± 4.4 hours. Mechanism of injury was intercourse in 26 of 30 fractures with the remaining attributed to masturbation or "rolling over." Immediate surgical repair was offered to all patients. Twenty-seven patients underwent surgery. Urethral injury was noted in 5 of the 27. The site of fracture was at the proximal shaft in 11, mid shaft in 12, and distal shaft in 4 patients. The mean follow-up period was 14.3 ± 15.8 weeks. Nine patients reported new mild erectile dysfunction or penile curvature. One patient reported new irritative voiding symptoms. CONCLUSION: The most common mechanism of penile fracture was from sexual intercourse, and frequent concomitant urethral injuries were observed. The frequency of concomitant urethral injury was higher than in previous studies. Although we observed high incidence of erectile dysfunction or penile curvature with early surgical repair, we retain it as the favored approach.
