Surgeon experience with penile fracture

Purpose: The experience of a single surgeon with a series of 34 penile frac tures, including 29 corrected surgically and 5 managed conservatively, at 3 large inner city medical centers in an 11-year period is presented. Standa rd diagnostic and therapeutic modalities are described that have evolved wi th time. Materials and Methods: Between 1989 and 1999, 34 patients 18 to 38 years ol d (mean age 27 at presentation) were evaluated after blunt trauma to the er ect penis. The interval from injury to presentation was between 6 and 72 ho urs. Of these patients 32 and 2 had been injured during sexual intercourse and masturbation, respectively. Surgery in 29 cases involved a degloving in cision, and intraoperative evaluation of the corpora and urethra by radiogr aphy or saline injection. Five patients were treated conservatively for pre sumed penile fracture after they refused diagnostic confirmation and/or sur gery. Results: Injury involved unilateral and bilateral corporeal rupture in 25 a nd 3 cases, respectively, and urethral injury in 5. Urinalysis in 6 patient s demonstrated microscopic hematuria with 5 to 10 red blood cells, although there were several false-negative urethrograms and cavernosograms. At foll owup 33 of the 34 patients available reported erection adequate for interco urse without erectile or voiding dysfunction, while 2 reported mild to mode rate curvature. Conclusions: A degloving procedure with a urethral catheter in place provid es the best exposure and orientation. In addition, saline injection may dem onstrate additional corporeal body and/or urethral pathology as well as ass ess the integrity of repair. Although surgical repair was not associated wi th serious sequelae, a small subgroup of patients with presumed penile frac ture also had no sequelae.