Surgical Treatment Of Penile Fracture Research Articles

EVALUATION OF SEXUAL FUNCTION INPENILE FRACTURE SURGERY PATIENTS

To assess the effects of surgical treatment of penile fracture on sexual function including psychological effects due to this traumatic experience. A prospective study was carried out at Department of Urology in Ibne Sina Hospital & MMDC Multan September 2021-September 2022. A total of 20 men undergoing surgical treatment for penile fractures were selected for the study. A detailed physical examination was done and subjects were questioned about psychological sexual problems and erectile dysfunction, penile nodules and penile curvature post-surgery. The average age of study patients was 37 years with an age range of 18-65 years. Two patients (10%) reported penile curvature. Erectile dysfunction was recovered in 17 patients (85%), six months after the surgery. 15 patients (75%) developed a fear of future penile fracture. 13 patients (65%) changed their sexual habits like avoiding vigorous sexual intercourse. Surgical treatment of penile fractures can lead to various postoperative complications both physical and psychological but they develop late in time after surgery and patients should seek treatment for such complications.

Sexual Function Outcomes After Surgical Treatment of Penile Fracture.

IntroductionPenile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection.AimOur study aims to evaluate patients with penile fracture and to identify the factors that may influence the sexual function after surgical repair.MethodsA total of 138 patients who were diagnosed with penile fracture between January, 1999 and December, 2018 were reviewed. Clinical features, perioperative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed.Main Outcome MeasuresSexual function was evaluated by three parameters six months after surgical repair: International Index of Erectile Function-5 (IIEF-5) questionnaire, penile curvature and the presence of a painful intercourse. All factors that could potentially influence these parameters were analyzed.ResultsThe mean age was 31.2 years (19-55). Presentation delay ranged from 1 to 5 days (mean = 16.8 hours) while surgery delay was 14.3 hours ().The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 62 cases (44.9%). On multivariate analysis, we found that the presentation delay and the fracture site located in the proximal shaft of the penis showed significant difference in the occurrence of postoperative ED (P = 0.03 and P = 0.015 respectively). Presentation delay, elective incision and tuncial leak located in the proximal shaft (P = 0.045; P = 0.018 and P = 0.022 respectively) were associated with higher penis curvature.ConclusionImmediate surgical repair and circumferential degloving incision for tunical leaks located in the proximal shaft of the penis are recommended in order to decrease the incidence of ED after surgical repair of penile fractures. Ouanes Y, Saadi MH, Alouene HH, et al. Sexual Function Outcomes After Surgical Treatment of Penile Fracture. Sex Med 2021;9:100353.

Surgical treatment of penile fracture accompanied by complete urethral rupture

Surgical treatment of penile fracture accompanied by complete urethral rupture

Lessons learned after 20 years' experience with penile fracture

ABSTRACTObjective:To report our experience over the past 20 years in the diagnosis and surgical treatment of penile fracture (PF).Materials and methods:Between January 1997 and January 2017, patients with clinical diagnosis of PF were admitted to our facility and retrospectively assessed. Medical records were reviewed for clinical presentation, etiology and operative findings. Postoperative complications, sexual and urinary function were evaluated.Results:Sexual trauma was the main etiological factor, responsible for 255 cases (88.5%): 110 (43.1%) occurred with the “doggy style” position, 103 (40.3%) with “man on top” position, 31 (12.1%) with the “woman on top” position and 11 (4.3%) in other sexual positions. The most common findings in the clinical presentation were hematoma, in all cases and detumescence in 238 (82.6%). Unilateral corpus cavernosum injuries were found in 199 (69%) patients and bilateral in 89 (31%) patients. Urethral injuries were observed in 54 (18.7%) cases. Nine (14.7%) patients developed erectile dysfunction and eight (13.1%) had penile curvature. Only two (3.7%) patients had complications after urethral reconstruction.Conclusions:PF has typical clinical presentation and no need for additional tests in most cases. Hematoma and immediate penile detumescence are the most common clinical findings. Sexual activity was the most common cause. The ‘doggy style’ and ‘man-on-top’ was the most common positions and generally associated with more severe lesions. Concomitant urethral injury should be considered in cases of highenergy trauma. Surgical reconstruction produces satisfactory results, however, it can lead to complications, such as erectile dysfunction and penile curvature.

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

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.

Penil Fraktüre Bağlı Erektil Disfonksiyonu Önlemek İçin Cerrahi Ne Zaman Yapılmalıdır?

Objective: To analyze the outcomes of the patients who underwent surgical treatment of penile fracture especially emphasizing the effects of the time of surgery on erectile function of the patients. Material and Methods: Between 2007 and 2019, 31 patients who were consulted with the complaints and suspicion of penile fracture to the Emergency Department of Pamukkale University Hospitals were evaluated retrospectively. Erectile functions both prior to the surgery and at postoperative 3rd month were evaluated. The patients who had an International Index of Erectile Function-5 (IIEF-5) decrease in the follow-up before the procedure and the patients who received medical treatment and no change in IEFF were divided into two groups. Compatibility of variables to normal distribution was evaluated with the Kolmogorov Smirnov test. The results were expressed in 95% confidence interval and p<0.05 was considered statistically significant. Results: In the study conducted on the etiology of a decrease in IEFF and the need for treatment after surgery, it was found that the rate of application to the emergency room within the first 6 hours statistically decreased the rate significantly. In addition, it has been found that the surgical application in the first 12 hours decreases both IEFF and the need for treatment in the IEFF. Conclusion: Penile fracture is a rare urological emergency. Erectile dysfunction which can be seen after penile fracture, is significantly reduced with early application of penile fracture within 6 hours to the hospital and surgical repair within the first 12 hours.

Re: Impact of Surgical Treatment of Penile Fracture on Sexual Function.

Re: Impact of Surgical Treatment of Penile Fracture on Sexual Function.

PS-07-006 Long-term Results in surgical treatment of penile fracture

Penile fracture is a common urological trauma seen in Vietnam.This study is to review the causes, symptoms and the outcome of penile fracture in Binh Dan Hospital. A case series of penile fracture being treated by immediate surgery in Binh Dan Hospital from January 2012 to September 2016. 131 cases were admitted in our study. Mean age was 38.1 years old. Mean follow up was 11.44 ± 8.31months. Masturbation cause was more frequent (81 cases) than intercourse (50 cases). Patients had presented themselves with experiencing a cracking sound and bent penis. All patients experienced penile swelling with ecchymosis. 82 patients reported hearing a “snap or cracking” sound and 93 cases feeling painful in the penis. Immediate surgery was performed in all cases. Fracture on the right side showed to be more frequent than the left side (97 of 131). In one special case, fracture on both side of cavernous corpus was presented. Most cases had the site of fracture in the proximal of the penis followed by middle and the distal fracture was the rarist (3 cases). The mean length of the fracture measured 1.37 cm. All patients have sexual intercourse: 6 ± 2.3 weeks. We use SHIM -5 questionaires to ascces patient after surgery and we have Results: 92% patients have SHIM score > 21 and 8% patients have SHIM score: 17 – 21. 16% patients had psychological effects due to penile fracture, 12% patient had pain on erection, 01 case complain has PE and 01 case has mild penile curvature and plaque detected on the penis.

Impact of Surgical Treatment of Penile Fracture on Sexual Function

ObjectiveTo conduct a comprehensive assessment of sexual function of patients undergoing surgical treatment of penile fracture (PF), covering psychological aspects related to trauma. MethodsPatients undergoing surgical treatment of PF from January 2014 to August 2017 were followed-up in our department for at least 6 months. The patients underwent a detailed clinical follow-up, including physical examination and were interviewed about any evidence of erectile dysfunction, penile nodules, or curvature acquired after surgery, besides psychological sexual problems. ResultsA total of 58 patients conducted the follow-up. The mean age was 38.5 years (range: 18-66 years). Eight (13.7%) patients complained of penile curvature after surgery. Postoperative erectile function was recovered after 6 months in 50 (86.2%) cases. After the last evaluation at 18 months, only 1 patient developed persistent erectile dysfunction (ED) and color duplex Doppler ultrasound excluded a vascular etiology. Psycho-sexual evaluations showed that 45 (77.5%) patients feared a new episode of PF. Changes in sexual habits, such as avoiding vigorous sexual intercourse, was reported by 40 (68.9%) patients. Finally, patients with performance anxiety and those who reported a negative impact on sexual life were more susceptible to the development of ED (P = .0337 and P = .0418, respectively). ConclusionSexual complications after surgical treatment of PF are unusual but may occur in the late postoperative period and should be treated. Psychological sequela is very common, causing fear of recurrence and psychogenic ED, resulting in negative impact on the sexual life of these patients, which should be monitored closely.

AB036. Long-term results in surgical treatment of penile fracture

BackgroundPenile fracture is a common urological trauma seen in Vietnam. Up to now, immediate surgical management has been the care standard. There have been 3–5 cases per month admitted to Binh Dan Hospital. This study is to review the causes, symptoms and the outcome of penile fracture in Binh Dan Hospital.MethodsA case series of penile fracture being treated by immediate surgery in Binh Dan Hospital from January 2012 to September 2016.ResultsA total of 131 cases were admitted in our study. Mean age was 38.1 years old. Mean follow up was 11.44±8.31months. Masturbation cause was more frequent (81 cases) than intercourse (50 cases). Patients had presented themselves with experiencing a cracking sound and bent penis. All patients experienced penile swelling with ecchymosis. In total, 82 patients reported hearing a “snap or cracking” sound and 93 cases feeling painful in the penis. The clinical characteristics and presentations were diagnosed in all of the patients, then the diagnosis was confirmed by penile ultrasonography. Immediate surgery was performed in all cases. Fracture on the right side showed to be more frequent than the left side (97 of 131). In one special case, fracture on both side of cavernous corpus was presented. Most cases had the site of fracture in the proximal of the penis followed by middle and the distal fracture was the rarist (3 cases). The mean length of the fracture measured 1.37 cm. All patients have sexual intercourse: 6±2.3 weeks. We use SHIM-5 questionnaires to access patient after surgery and we have results: 92% patients have SHIM score >21 and 8% patients have SHIM score: 17–21. A total of 16% patients had psychological effects due to penile fracture, 12% patient had pain on erection, 01 case complain has PE and 01 case has mild penile curvature and plaque detected on the penis.ConclusionsMasturbation was the most common cause of penile fracture in our study. Our study also showed that fracture was more often in the proximal right side of the penis. Immediate surgery should be performed to insure excellent results.

Sexual complications of penile frature in men who have sex with men.

ABSTRACTObjectives:Evaluate the demographic data, etiology, operative findings and results of surgical treatment of penile fracture (PF) in men who have sex with men(MSM) with emphasis on sexual complications.Materials and Methods:We studied 216 patients underwent surgical correction of PF at our hospital. Patients self-identified as MSM were followed for at least 6 months. Demographic data, presentation, operative findings, International Index of Erection Function - 5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool.Results:Of 216 PF cases, 4 (1.8%) were MSM. All cases resulted from sexual activity and all patients reported using the “doggy style” position during anal intercourse. Unilateral or bilateral injury of corpus cavernosum was found in 2 patients each. One (25%) patient had complete urethral injury associated with bilateral corpus cavernosum lesion. During the follow-up period, all patients developed some type of sexual complication. One patient reported penile pain during intercourse. Another patient experienced low sexual desire and premature ejaculation. This patient was also dissatisfied with the aesthetic result of the surgical scar and complained about decreased penis size after surgery. The third case developed delayed ejaculation. The fourth patient experienced mild to moderate erectile dysfunction. This same patient presented with penile curvature. Finally, palpable fibrotic nodules in the operative area were observed in all cases.Conclusions:Sexual activity in the “doggy style” position was the commonest cause of PF in MSM. Sexual dysfunction is always present in gay man after surgery for PF. However, additional studies with larger samples should be coinducted.

346 Delay of surgical treatment of penile fracture results in poor functional outcome: Results from a large retrospective multicenter European study

346 Delay of surgical treatment of penile fracture results in poor functional outcome: Results from a large retrospective multicenter European study

Early Surgical Treatment of Penile Fracture: Our Experience with 19 Patients

Early Surgical Treatment of Penile Fracture: Our Experience with 19 Patients

Delayed Consultation and Treatment of Penile Fracture: A Case Report

Introduction: A case of penile fracture referred three days after the injury is reported, highlighting the potential advantages of delayed rather than acute treatment, once the hematoma and swelling caused by trauma had decreased. Case presentation: A 31 year-old-man was diagnosed with fracture of the left corpus cavernosum that had occurred three days before. Due to the patient desire, surgical treatment was delayed and performed at day nine of penile fracture, with an incision limited to the penoscrotal angle. There was a rupture of the left corpus cavernosum and laceration of the corpus spongiosum of the urethra, which were repaired with an absorbable suture. The patient recovered erections without curvature of the penis, and with an almost invisible skin scar. Conclusion: There is an overwhelming consensus on the need for surgical treatment of penile fracture. Recently, it has been proposed that the repair could be made on a delayed rather than an emergency basis, once the hematoma and inflammation caused by trauma had reduced, and using a short incision, as close as possible to the point of penile fracture. The case here presented highlights the advantages of these options, coincidental with the delayed consultation by the patient.

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, >50 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, >50 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

Surgical treatment of penile fracture

Surgical treatment of penile fracture

Long-Term Outcome of Surgical Treatment of Penile Fracture Complicated by Urethral Rupture

The combination of lesions of the penile urethra and the corpus cavernosum is rare and is likely to worsen the immediate and long-term prognosis. To assess the late effects of penile fractures complicated by urethral rupture treated by immediate surgical intervention. Fourteen patients with concomitant urethral rupture were treated surgically at our center. Those patients were seen in the outpatient follow-up clinic and were re-evaluated. Sexual Health Inventory for Men questionnaire, local examination, uroflowmetry and penile color Doppler ultrasound. The most common cause of penile fracture is sexual intercourse (50%). The site of tunical tear was in the proximal shaft of the penis in 3 patients (21%) and in the mid of the shaft in 11 patients (79%). Urethral injury was localized at the same level as the corpus cavernosum tear in all cases; and it was partial in 11 cases and complete in 3. Long-term follow-up (mean=90 months) was available for 12 patients; among whom there was no complications in 4 (33%), painful erection in 1 (8%), erectile dysfunction in 2 (17%), and palpable fibrous nodule in 5 (47%). All patients had a normal urinary flow except one who developed relative urethral narrowing that required regular dilatation for 1 month. The urethral injury complicating penile fracture is often partial and localized at the level of the corpora cavenosa tear. Standard treatment consists of immediate surgical repair of both urethral and corporal ruptures with no harmful long-term sequelae on urethral and erectile function in most of patients.

Long-Term Results of Immediate Surgical Treatment of Penile Fracture

Purpose: Penile fracture is a rare but serious urological condition. Immediate surgical repair is widely accepted as the treatment of choice in penile fracture. The aim of this study is to investigate the long-term outcome of immediate surgical treatment of penile fracture. Materials and Methods: This is a retrospective study of 12 men with penile fracture who were treated in the Department of Urology, Sanggyepaik Hospital, Seoul, Korea from January 2000 to June 2005. Diagnosis was made clinically and was confirmed by cavernosography in all our patients. All patients underwent immediate surgical repair, within two days after trauma, using a degloving incision. The long term results of the immediate surgical repair were evaluated using questionnaire on outpatient department visiting or telephoning. Results: The median patient age was 43 years (range, 18 to 57 years). The median follow-up was 32 months (range, 14 to 60 months). Of these patients, 8 (66.7%) patients were injured during sexual intercourse, whereas 4 (33.3%) patients were injured during masturbation. All patients were treated by immediate surgery. All patients reported satisfactory, painless erectile function; two developed penile curvature and one had a penile nodule. Conclusions: Immediate surgical repair of penile fracture is effective, restores erectile function, and the incidence of complications is low. (Korean J Urol 2009;50:165-168) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome

To review the preoperative diagnostic evaluation and surgical treatment of penile fracture, as the condition is a urological emergency that requires immediate surgical exploration and repair. Between January 2003 and October 2007 eight patients presented to the emergency department with penile fracture after sexual intercourse. The clinical presentation, preoperative evaluation and imaging, surgical technique, and postoperative care were assessed to determine the optimal patient outcome. Seven of the eight patients were treated surgically and one refused surgical intervention. Four cases involved unilateral corporal injury, two involved unilateral corporal injury with an associated urethral injury, and one involved bilateral corporal injury with an associated urethral injury. Although retrograde urethrogram were taken of all three urethral injuries, none of them revealed the injury. Diagnostic cavernosography or magnetic resonance imaging were not used in any of the patients. No complications occurred in the patients treated surgically. Preoperative imaging should not delay surgical repair. If an associated urethral injury is suspected, flexible cystoscopy is recommended in the operating room, as opposed to a retrograde urethrogram. A subcoronal circumcising incision is recommended to deglove the entire penile shaft and have complete access to all three corporal bodies, as well as the neurovascular bundle. Saline mixed with indigo carmine can be injected both into the corpora cavernosum or corpus spongiosum via the glans penis, after a tourniquet is placed at the base of the penis, to evaluate the surgical repair and to determine if there are any missed injuries.