150 The Impact Of Surgical Treatment Of Penile Fracture On Long-term Erectile and Urinary Functions

Abstract

Penile fracture (PF) is a relatively uncommon genitourinary traumatic injury that often necessitates timely surgical intervention. The aim of this study is to examine the impact of an early vs delayed surgical interventions for PF on the long-term erectile and urinary outcomes. Patients underwent surgical treatment for traumatic penile fractures (PF) from March 2010 to October 2019 at our institution were evaluated to characterize demographics, surgical interventions and long-term outcomes. Patients with a history of non-traumatic PF including Collagenase intralesional injections were excluded. International Index of Erectile Function (IIEF-5) utilized for objective post-operative erectile assessments. A total of 23 patients evaluated. The mean age was 38.5 years (range 18-52 years) and mean BMI of 28.6. Ethnicity were 11 African American, 6 Caucasian, 4 Hispanic and 2 unknown. Mean follow up was 11.6 months (range 6-18 months). No history of erectile dysfunction (ED) or Peyronie’s disease (PD) prior to trauma. Majority of patients 18/23 (78%) had surgical interventions (PF repair) within 24hrs (range 6-18hrs) (early repair), whereas 5/23 (22%) patients received surgical repair beyond 24hrs (range 3-21 days) (delayed repair). In both groups, the degloving circumcision incision was the preferred approach at time of PF repair 18/23 (78%), compared to ventral raphae incision 5/23 (22%). All patients underwent either unilateral or bilateral corpora cavernosa repair of PF, and 6/23 patients (5 vs 1 patients in early vs delayed group) underwent anastomotic urethroplasty for concomitant corpora spongiosum rupture. Although the most common complication following surgical repair of PF was ED (62%), erectile function recovery after six months were 15/18 (83%) vs 1/5 (20%) in the early vs delayed repair groups respectively (p<0.05) (Table 1). Seven patients (3 in early and 4 in delayed groups) developed severe and persistent ED (IIEF-5: 5-7) at time of last follow-up. Eight (17%) patients complained of penile curvature after surgery (6/18, 33% vs 2/5 40%). Intracavernosal injection test showed deviation <30 degree in all cases. Subjective penile shortening was reported in both groups (1 in each group). In the delayed repair group, only 1 patient required reoperation for urethral stricture disease at site of prior urethroplasty and one patient developed transient priapism.