BERKELEY, CA (UroToday.com) - The rare but alarming presentation of penile fracture provides the urologist with an opportunity to immediately and definitively address a very distressing condition. We have found that patients with this condition are often embarrassed, which can lead to ambiguous or evasive descriptions of the events leading to injury. While the urologist must be sensitive to these issues, a thorough history and physical exam is needed to establish a clinical diagnosis.
Nearly all of the largest studies published about penile fractures have traditionally come out of the Middle East. We believe that the penile fracture injuries sustained in the Western hemisphere are very different than those sustained by men in the Middle East -- specifically, that they are more likely to be caused during intercourse as opposed to during taqaandan (forcibly bending the penis). Our study did, indeed, demonstrate a higher rate of concomitant urethral injury, a higher number of proximal injuries, and a higher rate of de novo erectile dysfunction or penile curvature than the Eastern studies have reported, supporting the hypothesis that these are distinct entities.
Nonetheless, we agree with the recommended approach to management, notably early operative exploration with a judicious use of pre-operative imaging and a high degree of suspicion for concomitant urethral injury. Occasionally, when the diagnosis of penile fracture is in question despite a high degree of suspicion, an MRI can be obtained, however one must be wary of false negatives.
Our study was clearly not powered to draw concrete conclusions about the optimal incision, however, based on our analysis, we favor reserving a ventral or longitudinal incision to those cases in which men present with focal tenderness. Any significant hematoma can impair decision-making, so men with a true “eggplant deformity” will undergo a circumcising incision.
Again, due to the potentially embarrassing nature of the injury, the urologist must be sensitive but attentive in establishing follow-up care. Our study showed a fairly high rate of organic sexual dysfunction, including curvature of the penis, and other studies have shown that psychosocial comorbidities and sexual apprehension are also very common after this type of injury. Thus, we believe that these men should be routinely followed in clinic to address potential issues.
Written by:
Daniel Swanson and Jason Hedges as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Oregon Health & Science University, Portland, OR USA
Penile fracture: Outcomes of early surgical intervention - Abstract