Penile fractures: the successful outcome of immediate surgical intervention

The data of 60 patients admitted to Mansoura Urology and Nephrology Center with penile fractures and treated by immediate surgical repair were reviewe d with respect to their presentation, investigations, operative and post-op erative details. Forty-nine patients were followed up regarding penile curv atures, plaques and erectile function. Patients reporting decreased erectil e function were further assessed by evaluating their response to intracaver nous injection of PGE(1) and by penile color duplex Doppler ultrasonography . All of our patients had the classic clinical presentation of penile swellin g and ecchymosis. Only five patients had accompanying urethral rupture. Pen ile ultrasonography was used to confirm the diagnosis in 23 patients. Immed iate exploration was done using subcoronal circumferential incision in abou t two-thirds of the cases. All tunica albuginea ruptures were unilateral ex cept one case which was bilateral. Interrupted absorbable sutures were used for repair in most of the patients. Urethral repair was done in five cases . Delayed complications were detected in only six cases (12.2%) in the form of mild penile curvature on erection, plaques and/or mild erectile dysfunc tion. Intracavernous injection (ICI) of PGE, and penile duplex Doppler show ed a normal pattern in three patients with erectile dysfunction while the f ourth showed incompetent venoocclusive mechanism. Psychosexual consultation was required for two of these patients while the third was successfully ma naged by self-ICI of PGE(1) We conclude that the excellent outcome of our patients parallels other repo rts of early surgical repair regarding low morbidity, short hospital stay a nd rapid functional recovery. There is a low incidence and degree of erecti le dysfunction among repaired patients; however, it should be thoroughly in vestigated and properly managed. Ultrasonography is easy and helpful; howev er, the more invasive cavernosography and/or magnetic resonance imaging are indicated when the case is atypical, or the diagnosis of rupture of tunica is suspicious.