Long-term outcomes comparison of immediate and delayed surgical intervention for penile fracture: A systematic review and meta-analysis

Abstract

Penile fracture is a rare urological trauma that needs immediate repair. However, several reports stated that a delayed surgical repair might be acceptable. Thus, we aim to evaluate the long-term outcomes of immediate and delayed surgical intervention for penile fracture treatment. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to perform this meta-analysis. A comprehensive search through PubMed, Scopus, and Science-direct was performed using Medical Subject Headings (MeSH®) Terms. The primary outcome analyzed in this study was long-term complications, including erectile dysfunction (ED), penile curvature, penile pain, and palpable plaque. The publication bias was assessed using funnel plot and Harbord's test. All analyses were performed using STATA® 16 and the protocol for the meta-analysis has been registered in PROSPERO (CRD42022315154). A total of 10 studies were included in the analysis, comprising 2 prospective studies, 5 retrospective studies, and 3 case series, for a total of 531 patients with penile fractures. From the pooled analysis, lower ED incidence in the immediate surgical repair group was significant on less than 12 months follow-up (OR: 0.36, 95% CI: 0.15 to 0.89, P = 0.03). However, this difference was not significant on longer follow-up (OR: 1.39, 95% CI: 0.29 to 6.58, P = 0.68). No significant difference was found in the incidence of palpable plaque (OR: 0.74, 95% CI: 0.26 to 2.12, P = 0.57). Additionally, penile pain/paresthesia (OR: 0.17, 95% CI: 0.06 to 0.51, P < 0.01) and penile curvature incidence (OR: 0.17, 95% CI: 0.06 to 0.47, P < 0.01) was also significantly lower in the immediate repair group than the delayed approach group. The funnel plot analysis and Harbord's test did not suggest any publication bias ( P = 0.804). Immediate surgical intervention remains the best option for penile fracture treatment due to reduced risk of long-term complications, including penile pain and penile curvature.