PD12-07 PENILE FRACTURE SURGERY: DOES IT IMPACT SEXUAL FUNCTION?

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD12-07 PENILE FRACTURE SURGERY: DOES IT IMPACT SEXUAL FUNCTION? Alberto Costa Silva, Vasco Rodrigues, Carlos Martins-Silva, and Afonso Morgado Alberto Costa SilvaAlberto Costa Silva More articles by this author , Vasco RodriguesVasco Rodrigues More articles by this author , Carlos Martins-SilvaCarlos Martins-Silva More articles by this author , and Afonso MorgadoAfonso Morgado More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical exploration with closure of tunica albuginea is the proposed treatment for penile fracture. The recovery of sexual function is the main result desired by the Urologist and the patient. METHODS: Retrospective analysis of data from patients undergoing surgical correction penile fracture between 2007 and 2022 in a tertiary hospital. Trauma mechanism, extension, laterality and location of the lesion and the presence of urethral lesion were evaluated. The number of weeks until resumption of sexual activity was obtained. Erectile function was assessed with the International Index of Erectile Function 5 (IIEF5). The evolution of erectile function after the episode was classified as worsening, maintenance or improvement. The presence of glans hypoesthesia, penile curvature, penile nodule palpation were also evaluated. Self-satisfaction with the scar and self-perception of body image was rated from 0 to 10. RESULTS: A population of 69 patients with a mean age of 42.30±12.98 years (mean±standard deviation) was obtained. Sexual intercourse, self-inflicted injury and masturbation were the cause of 85.5%, 4.3% and 2.9% of fractures, respectively. The diagnosis was supported by ultrasound in 62.3%. The lesion affected the right cavernous in 43.5%, the left in 40.6% and both in 15.9%. The dorsal and ventral location of the lesion appeared in 26.1% and 73.9%, corresponding to 36.2%, 40.6% and 23.2% in the proximal, middle and distal thirds, respectively. Acquired penile curvature appeared in 14.5% and none required surgical correction. The median postoperative IIEF-5 was 24. Erectile function deteriorated to levels of dysfunction in 5.8% (n=4). Of these, two have an IIEF-5 of 18 and two of 15, with one of the latter taking avanafil 100 mg. Decreased erectile function was associated with the distal location of the lesion (p=0.028) and the presence of curvature (p=0.038). The glans hypoesthesia appeared in 2.9% and was associated with the distal location (p=0.033). The sensation of a penile nodule appeared in 4.3% and was more frequent in bilateral lesions (p=0.039). The resumption of sexual activity occurred in a median of 7 weeks, not being associated with any of the variables evaluated. Self-satisfaction with body image had a median of 9, with lower values associated with the presence of curvature (p=0.009), more extensive lesions (p=0.023) and concomitant urethral injury (p=0.025). A median of self-satisfaction with the scar of 8 was obtained, associated with the presence of curvature (p=0.004). CONCLUSIONS: In our study, fractures of the cavernous bodies with distal involvement are associated with degradation of erectile function and hypoesthesia of the glans, being more frequent in patients with later resumption of sexual activity. The cases of erectile dysfunction identified were mild and only one required pharmacological treatment. The curvature acquired after fracture did not require surgical correction, although it is associated with worsening erectile function, less self-satisfaction with the scar and with body image, the latter also being associated with more extensive injuries and concomitant urethral injury. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e402 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Costa Silva More articles by this author Vasco Rodrigues More articles by this author Carlos Martins-Silva More articles by this author Afonso Morgado More articles by this author Expand All Advertisement PDF downloadLoading ...