Penile Fracture Research Articles (Page 1)

Isolated Urethral Injury Without Penile Fracture: A Case Report

Prolonged ischemic priapism (PIP) is a clinically challenging scenario with a high rate of erectile dysfunction for cases lasting more than 48h. To report surgical and functional outcomes of patients with PIP treated by penoscrotal decompression (PSD). Retrospective data analysis of patients with PIP who underwent PSD with a proximal penile shaft surgical incision compared to the original technique after failing first-line treatment between 2019 and 2024 in two tertiary referral centers. The primary objective was the rate of successful procedures defined as the resolution of pain and no priapism recurrence. Secondary objectives were perioperative surgical outcomes and sexual function according to International Index of Erectile Function-5 score and progression to penile prosthesis (PP). Treatment success and sexual outcomes were also reported according to time of presentation of PIP. Overall, 22 (85%) and 4 (15%) patients underwent bilateral and unilateral PSD, respectively. The median duration of priapism was 47 (36.5-58.8) hours, with half of the patients treated after 48h. Penoscrotal decompression was successful in 18 (69%) cases, with a higher success rate for bilateral procedures (73%). Immediate penile detumescence was observed in 96% of cases, while 92% had complete pain relief. Efficacy varied with timing, with better outcomes for procedures performed within 36h. Two (8%) patients had postoperative complications. Overall, 21 patients had documented sexual function status (median interquartile range follow-up of 10.4 [5.5-28.3] months) with worse ED in those who failed PSD (57% vs. 38%, P= .6). Two out of 13 (15%) patients developed an infection after PP insertion requiring explantation, while 86% reported satisfactory erectile function with or without PP insertion. The variation to the PSD technique herein described has several potential advantages. A penile shaft incision facilitates quicker and more convenient exposure of the corpora, making it accessible for general urologists experienced in penile fracture repair. This is the series with the longest follow-up data on patients treated with PSD for PIP. Limitations are the retrospective design of the study and the small cohort considered due to the rarity of PIP. Penoscrotal decompression is an effective and safe alternative treatment for patients with PIP. Its efficacy remains time-dependent, particularly when performed within 36h, with bilateral decompression achieving improved success rates.

Aims: Penile fracture is a rare but clinically significant urological emergency that may result in erectile dysfunction, penile curvature, and long-term complications if not promptly managed. Despite its clinical importance, the global research landscape on penile fracture remains fragmented and limited in scope. Bibliometric analysis provides an opportunity to systematically evaluate scientific productivity, citation impact, and collaboration networks in this field. The aim of this study was to conduct the first comprehensive bibliometric mapping of penile fracture research, focusing on publication productivity, citation performance, collaboration patterns, and emerging thematic trends. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection database covering the period 1980 2024. A comprehensive search strategy with predefined inclusion and exclusion criteria was applied to identify original articles related to penile fracture. Data extraction and analysis were performed using Microsoft Excel and BibExcel. Visual mapping and network analyses, including co-authorship, co-occurrence of keywords, and bibliographic coupling, were conducted using VOSviewer. Results: A total of 255 original research articles were identified, authored by 1.064 researchers from 36 countries and published across 93 journals. The United States, Turkiye, and Egypt were the most productive countries, while the Journal of Urology, Urology, and the Journal of Sexual Medicine emerged as the most influential journals. Leading authors included Favorito LA, Koifman L, and Barros R. Keyword co-occurrence analysis revealed strong associations between “penile fracture,” “erectile dysfunction,” and “trauma,” while emerging trends highlighted diagnostic modalities such as ultrasonography and MRI. Bibliographic coupling identified a limited number of pivotal publications shaping the knowledge base. Conclusion: This study provides the first comprehensive bibliometric evaluation of penile fracture research, highlighting global publication trends, influential contributors, and evolving research themes. The findings underscore the need for increased international collaboration and methodologically robust prospective studies to strengthen the evidence base. By identifying research gaps and emerging priorities, this study not only strengthens the scientific evidence base but may also inform future guideline development and optimize clinical management strategies for this rare but significant urological emergency.

Penile fracture is an uncommon but well-recognized urological emergency characterized by rupture of the tunica albuginea of the corpora cavernosa following blunt trauma to the erect penis. We report the case of a 45-year-old man admitted four hours after sexual intercourse, presenting with an audible cracking sound, immediate pain, and sudden penile deformity. Clinical examination revealed diffuse ecchymosis, hemorrhagic swelling, and axial deviation. High-resolution ultrasound using a 7–12 MHz linear probe demonstrated a 23 mm ventrolateral rupture of the tunica albuginea of the left corpus cavernosum, associated with a heterogeneous para-cavernous hematoma. The contralateral corpus cavernosum, corpus spongiosum, and urethra were preserved. Color Doppler imaging showed no abnormal flow or arteriovenous fistula. Emergency surgical exploration allowed hematoma evacuation and tunical repair. Postoperative evolution was favorable, with resolution of edema, recovery of morning erections, and satisfactory erectile function. This case highlights the pivotal role of high-resolution ultrasound in diagnosing and localizing penile fractures, enabling prompt surgical repair that ensures optimal functional recovery and minimizes long-term complications.

Spinning Into Surgery: A Case of Penile Fracture Due to High-Risk Sexual Activity

ABSTRACTPenile fracture is a rare urological emergency that requires prompt diagnosis and treatment. We report a case of a 44‐year‐old male who sustained a penile fracture during sexual intercourse. Surgical exploration and repair were performed within 10 h. The patient experienced an uneventful recovery, highlighting the importance of early surgical management.

5-year follow-up after penile fracture repair: assessment of erectile and urinary outcomesusing validated questionnaires

Surgical management penile fracture

ObjectiveThis study evaluates the clinical outcomes of patients with suspected penile fractures who were managed conservatively after MRI excluded tunica albuginea rupture or fracture.MethodsA retrospective review was conducted over a seven‐year period, identifying patients who presented with symptoms suggestive of penile fracture. All patients who underwent MRI imaging to confirm or exclude the presence of a tunica albuginea rupture. Based on MRI findings, patients without confirmed fractures were managed conservatively, including instructions to avoid sexual activity and strenuous physical exertion. Follow‐up assessments were conducted to monitor long‐term complications, with a specific focus on erectile function, assessed via the International Index of Erectile Function (IIEF) and penile curvature.ResultsOf the 30 patients with suspected penile fractures, MRI excluded fractures in 63%. Among these conservatively managed patients, approximately 60% developed erectile dysfunction (ED) and 27% developed penile curvature. Even in cases without confirmed fractures, patients with contusions demonstrated significant post‐injury complications.ConclusionMRI is effective in ruling out penile fractures, supporting the use of conservative management when fractures are not confirmed. However, conservative treatment alone is associated with a notable rate of complications, suggesting the potential benefit of early penile rehabilitation to address functional outcomes in these patients.

Since its release in 2014, collagenase clostridium histolyticum (CCH) has become the most commonly used injectable therapy for Peyronie's disease (PD). While some studies have suggested modest improvements in curvature with use of CCH, others have found more significant gains. To determine predictors of improved curvature in men with PD treated with CCH. A prospective, sequential database has been maintained of all men with PD undergoing CCH injections since 2014. Clinical characteristics and responses to standardized and nonstandardized questionnaires were collected at baseline, during, and after treatment. Change in curvature was assessed using the "Most Recent" curvature assessment, and statistical analyses were performed to identify factors that correlated with greater curve improvements. A total of 826 men underwent at least one CCH series and comprise the current cohort. Univariate analysis demonstrated associations between greater curvature improvements in patients with more severe baseline curvature (0.5° greater improvement per increase in 1° baseline), hourglass deformities (3-10° greater improvement among moderate/severe men), number of CCH series administered (0-4° per series), strong nocturnal erections (11° higher), greater frequency of intercourse (0.6° per intercourse attempt per month), greater bother and psychological impact (as assessed by the Peyronie's Disease Questionnaire), and those who used RestoreX (5-20° depending on test). Worse outcomes were observed among men who self-reported decreased motivation (7°) as well as those with pure lateral curvatures (11°). Men who experienced hematomas, a popping sensation, and those with rapid detumescence during treatment also had more significant improvements in curvature (5°). On multivariate analysis, baseline curvature, lateral curve direction, hourglass/indentation deformities, RestoreX use, and suspected controlled penile fracture remained independently associated with better outcomes. Of all the factors assessed, RestoreX use was associated with the largest degree of improvement. These findings highlight several potential predictors of improved outcomes with CCH, which may be utilized by providers to help counsel patients deciding on medical versus surgical treatment of PD. The strengths include the largest single-center prospective database of PD patients undergoing CCH published to date and use of objective and validated instruments to track PD outcomes. Limitations include the single-center nature, diverse patient cohort, and change in CCH technique over time. Several baseline and treatment-related factors correlate with CCH outcomes. These data may assist both patients and providers as they relate to patient selection and counseling. The data also suggest the importance of patient motivation and active participation during the treatment course.

Current AUA urological trauma guidelines recommend prompt surgical intervention for patients presenting with acute penile fracture to minimize potential risks of erectile dysfunction and penile curvature. Given its relatively rare occurrence, there have been few large population-based studies evaluating real-world management of penile fracture. We hypothesized that there is variability in intervention for patients presenting with penile fracture associated with patients' clinical and demographic characteristics and hospital characteristics. The Trauma Quality Improvement Program database from 2007 to 2017 was analyzed, and patients with diagnosis codes for penile fracture were identified. Patient demographic data and hospital characteristics were analyzed. Multivariable analysis was performed to identify patient and hospital characteristics associated with surgical intervention for penile fracture. We identified 940 patients presenting with penile fracture. The median age was 39 (IQR: 31-47) years. Of the 940 patients, 658 (70%) underwent surgery for penile fracture during the index admission. On multivariable regression analysis, hospital teaching status, type of insurance, and absence of urethral injury diagnosis were significantly associated with the likelihood of intervention. In this large retrospective study, most patients underwent immediate penile fracture repair. However, several patients did not have surgery at the time of their presentation, which was associated with presenting to a nonteaching hospital, having government health insurance, and the presence of urethral injury. Advocating for prompt surgical management remains paramount for improving care for patients with penile fracture.

Long-term outcomes of penile fracture (PF) include erectile dysfunction (ED) and penile curvature. In this study, we aimed to present the functional and anatomical results of 182 patients who underwent PF repair surgery and to reveal the risk factors for ED and penile curvature in a relatively long follow-up period. Thirty (16.5%) patients suffered from ED and 18 (9.9%) patients had penile curvature, respectively in a median follow-up period of 66 (39-111) months. Presence of bilateral fractures (OR = 7.806; 95% CI = 2.083-29.261; p = 0.002), larger tunical defect size (OR = 1.099; 95% CI = 1.036-1.164; p = 0.002) and longer time between fracture and surgery (OR = 1.095; 95% CI = 1.036-1.157; p = 0.001) were stated as the independent risk factors for ED. Only larger tunical defect size was found as an independent risk factor for penile curvature (OR = 1.14; 95% CI = 1.063-1.221; p < 0.001). The cut-off values for predicting ED were 18.5 mm for tunical defect size, 14.5 h for time between fracture and surgery, and 41 years for age. The cut-off value for tunical defect size was 18.5 mm for penile curvature. Risk of ED increases among patients with extended tunical rupture and delayed surgical repair. Penile curvature manifests less frequently and seems to be associated with the size of the tunical defect.

Although penile fracture is a rare condition, the damage it may cause afterwards is challenging for patients. We aimed to investigate the relationship between late presentation to the hospital and the frequency of erectile dysfunction (ED) in patients with penile fractures. In our cross-sectional, retrospective study, the frequency and severity of ED were calculated according to the International Index of Erectile Function (IIEF) scoring in patients with penile fracture admitted to Dicle University Hospital in the inter-operative period between the event and the operation and the subsequent controls. The relationship between these two conditions was analysed. Forty-six patients who met the inclusion criteria were included in our study. The mean age was 37 (28-46) years. The mean preoperative IIEF was 25 (20-28), and the mean postoperative IIEF was 21.3 (15-27). The mean event-operation time was 9 (6-15) hours. The rate of sexual intercourse was 50%, trauma was 30%, development after masturbation was 11%, and other causes were 9%. Penile fracture is a real urological emergency, and as urologists, we need to intervene as early as possible in patients experiencing this condition. We found that patients who presented to the hospital more than 12.5hours after penile fracture had a significantly higher risk of developing ED or worsening ED in the subsequent period.

Introduction: Penile fracture is an uncommon urological emergency, best managed by early surgical intervention, but the data on subsequent sexual function is sparse. This study was designed to analyse the clinical spectrum and sexual function after penile fracture repair in Urology Department of BIRDEM General Hospital and other institutes in Dhaka, Bangladesh which were attended by the authors. Materials and Methods: This is a prospective observational study extending from January 2013 to November 2024, which included all the patients admitted with the diagnosis of fracture penis. The clinical presentation, aetiology and the details of the surgical management were noted. Patients were followed‑up for 36 months. They were evaluated for the presence of penile nodules or curvature, and the erectile function was objectively recorded using the Sexual Health Inventory for Men (SHIM) questionnaire and the Erection Hardness Score (EHS). Results: During the study, 22 cases of penile fracture received treatment. Median age at injury was 29 years, and injury due to rolling over the erect penis during morning tumescence (12/22) was the most common aetiology. Ultrasound was performed in 20 patients and could detect the injury with an 80% sensitivity. All cases were repaired through a subcoronal degloving incision. Patients were followed‑up 6 monthly for 36 months. Of the 22 patients, 18 were sexually active. The mean SHIM score was 21.36 ± 1.33 and the mean EHS was 3.21 ± 0.43. Three of the 22 patients developed penile nodule. One of them had penile curvature which was not bothersome. Conclusion: Penile fracture remains primarily a clinical diagnosis. Although prompt diagnosis and an emergent surgical exploration provides good outcomes in terms of preservation of erectile function, patients should be apprised about the problems of penile nodule and curvature. Bangladesh J. Urol. 2025; 28(1): 27-32

Surgical Outcomes Following Subcoronal Degloving Repair in Penile Fracture: A Retrospective Case Series

A "penile fracture" is a rare urological emergency. According to international literature, a clinical diagnosis is considered sufficient if the patient's history and clinical appearance are characteristic. Imaging modalities such as sonography, cavernosography, and MRI are appropriate diagnostic tools. Sonography is a fast, inexpensive and widely used imaging method; however, MRI offers a higher resolution. The current literature recommends timely surgical treatment.This is a retrospective, single-centre cohort study including all patients who presented at the University Hospital of Lübeck with a suspected penile fracture between 01 January 2018 and 30 September 2024.Sixteen patients were analysed. Eight patients presented on the day the trauma occurred.MRI morphology confirmed a rupture of the corpora cavernosa in 13 of 16 patients. The suspicion was not confirmed in 3 patients. Sonographic and MRI morphological findings correlated in 11 patients, sonography was false negative in 2 patients and false positive in 2 others. In 1 patient, both sonography and MRI yielded inconclusive results.Clinically, a deviation of the penis was seen in about 23% of fractures, 92% showed a haematoma, and about 23% of the patients with a rupture reported that they had heard a "cracking sound".The diagnosis can be established clinically, sonographically, and via MRI. Sonography is suitable for the initial assessment of whether there is an interruption in the continuity of the tuniga albuginea. In the hands of experienced examiners, this may be sufficient to precisely localize the defect. However, in rare cases where sonographic expertise is limited, MRI serves as a more sensitive imaging technique that can rule out differential diagnoses and localize defects.In summary, according to the literature, an MRI is helpful for treatment planning, but not necessary for surgical treatment. With a correlation of sonography and MRI in 69% of the cases we examined, sonography is a sufficient diagnostic tool for determining the indication for surgery. Based on our data, we consider a positive sonography to be sufficient for the initiation of further therapy. However, based on our evaluation, we would recommend MRI in cases of negative ultrasound findings with persistent clinical suspicion.

Penile fracture is a rare urological emergency that may cause erectile dysfunction (ED). We analyzed the factors affecting erectile function in patients who underwent surgical repair for the management of penile fractures. Eighty-two patients who underwent penile fracture surgery in the Department of Urology, University of Gaziantep (Gaziantep, Türkiye) between January 2012 and January 2023 were evaluated. Age, body mass index, time elapsed from the incident of penile fracture to surgery, size, laterality, level of the defect, causes of fracture, presenting signs and symptoms, and relevant complications were recorded. Erectile function of the patients was evaluated preoperatively and at postoperative 3 rd and 6 th months according to the International Index of Erectile Function-5 (IIEF-5) scoring system. The factors decreasing the erection quality of the patients after surgical repair of penile fractures were investigated using IIEF-5 scoring system. Only age, defect size, and time elapsed from fracture onset to surgery were found to be effective on the occurrence of ED ( P = 0.005, P < 0.001, and P < 0.001, respectively). In the receiver operating characteristic (ROC) analysis, the cut-off values were 12.5 mm for defect size ( P < 0.001), 8.5 h for the time elapsed from fracture onset to surgery ( P = 0.036), and 40.5 years for the age of the patients ( P = 0.005). Delayed surgery, defect size, and advanced age had significant and negative effects on erectile function in cases of penile fracture. Before repair of the defect, patients should be given appropriate counseling about the possibility of ED, and early penile rehabilitation should be initiated.

Abstract Objectives A “penile fracture” is a rare urological emergency. According to literature, the clinical diagnosis is sufficient. Imaging diagnostics such as sonography or MRI are suitable. Sonography is quick to use, inexpensive and more widely available than an MRI examination, which, however, has a higher resolution. The treatment recommendation in current literature is surgical treatment as quickly as possible. Methods This study is a retrospective and monocentric kohort study. Included were all patients consulting medical advice with a suspected penile fracture at the University Hospital of Luebeck between 01.01.2018 and 31.12.2023. Results 15 patients were analysed. 7 patients presented on the same day as the trauma, 3 patients on the following day. Clinically, 20% of fractures showed a deviation of the penis, 80% showed a haematoma and 20% of patients with a rupture reported having heard a “cracking sound”. MRI morphology confirmed a rupture of the corpora cavernosa in 13 of 15 patients. The suspicion was not confirmed in 2 patients. Sonographic and MRI morphological findings correlated in 11 patients, sonography was false negative in two patients and false positive in one. In one patient, both sonography and MRI were inconclusive. Conclusions The diagnosis can be made clinically, sonographically and with using MRI. Sonography is suitable for the initial assessment of whether there is an interruption in the continuity of the tuniga albuginea. For experienced users, this may also be sufficient to localize the defect. However, in rare cases with user-dependent individual sonographic expertise, MRI is a more sensitive imaging technique. In summary, according to the literature, an MRI is helpful for treatment planning, but not necessary for surgical treatment, especially if the approach is not only localized. With a correlation of sonography and MRI in 73% of the cases we examined, sonography is a sufficient diagnostic tool for determining the indication for surgery. Based on our data, we consider a positive sonography to be sufficient for the initiation of further therapy. However, based on our evaluation, we would recommend MRI in the case of a negative ultrasound and clinically existing suspicion. Conflicts of Interest None.

This article presents a clinical case of one of the rarest pathologies in emergency urology, previously described only five times in the global medical literature — rupture of the superficial dorsal vein with penile deviation. Clinical diagnosis of this condition is quite difficult without the use of additional imaging methods, which may not be available in emergency settings. However, establishing an accurate diagnosis in the shortest possible time allows for the most appropriate treatment using conservative or surgical methods. The paper provides an analysis of the causes, differential and clinical diagnosis, management strategies, and therapeutic principles with clear indications for surgical intervention. Currently, there are no clinical guidelines for the management of patients with rupture of the superficial dorsal penile vein. Patient complaints and physical examination, as well as Doppler ultrasound imaging, which allows assessing the vascular network of the penis, including the superficial dorsal vein, can assist in establishing a diagnosis of this condition. Magnetic resonance imaging can help identify tunica albuginea rupture, vascular injury, and penile fracture. If there is any doubt regarding the diagnosis, surgical intervention should be performed, including exploration of the corpora cavernosa and the urethra.

Imaging of the Urethra and Penis.