U.S. National Statistics on Penile Fracture

Abstract

We read with great interest the recent case report and literature review on penile fracture by Al-Shaiji et al. [1] The topic is of substantial public interest, primarily for prurient reasons, but public awareness that such a thing is physically possible is generally low. Despite a number of quality case reports and small single institution case series, the true incidence of penile fracture in the United States is unclear. In the interest of better understanding the frequency with which penile fracture occurs, we consulted the 2006 and 2007 National Inpatient Sample (NIS, a nationally representative weighted sampling of data from U.S. men) for hospital admissions secondary to penile fracture. According to the NIS, in the United States a total of 1,043 men were admitted to the hospital for penile fracture in 2006–07. Demographic information on these patients is presented in Table 1. The average age was 36.7 years (range 16–67). Although Caucasian men accounted for the largest proportion of patients seen, Hispanic and African-American men were overrepresented relative to national population data. There were no reports of Asian-American men with penile fracture, although case series from Japan have indicated that penile fracture can occur in this racial group [2]. Interestingly, conditions known to be co-morbid with erectile dysfunction were rare in this sample; this is logical, given that penile fracture typically requires application of pressure to a very rigid and inflexible phallus, a condition less likely to be present in men with impaired penile hemodynamics. Concomitant urethral injury was identified in 20.5% of subjects. All subjects underwent surgical repair with just 1.9% undergoing “delayed” repair, which is not surprising given the emergent nature of presentation. It is impossible to determine outcomes with this dataset, but the majority of studies have suggested recovery is excellent in cases where fracture is surgically repaired emergently [3–6]. Penile fracture has a substantial financial impact on those affected, as only 41% of men with penile fracture had some form of insurance. The mean length of stay was 1.3 days and the mean total charges were $12,932. Although it is not assessed in this study, occult costs in terms of lost wages and other expenditures may be significant. Although penile fracture is rare, consideration should be given to discussing this possibility with male patients when discussing safer sex, though we acknowledge this discussion is done far too infrequently. Of course, physicians must balance the provision of information about penile fracture during vigorous sexual activity with the risk of inhibiting sexual pleasure [7].