Urethral injury in penile fracture: a narrative review

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Buried penis repair: tips and tricks

ABSTRACT Obesity is increasing in prevalence worldwide and an increasingly commonly encountered condition is adult acquired buried penis (AABP). We review the current management of AABP and relevant literature. Management of AABP requires a combination of genitourinary reconstructive techniques and plastic surgery techniques that are unique to this condition. We offer our experience and tips and tricks for the treatment of AABP.

CT-guided minimally-invasive penile fracture repair

ABSTRACT We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.

Genital myiasis associated with genital piercing. Case report

ABSTRACT CONTEXT: Myiasis is caused by larval infestation that usually occurs in exposed wounds. Dermatobia hominis is the most common fly species responsible for this parasitic infection. Genital piercing is an ornamental practice used in certain social circles. At placement, it transverses the skin surface and, as such, may be related to complications. CASE REPORT: We report a case of a 31-year-old man with a history of wound infection secondary to genital piercing who was exposed to an environment with flies, leading to myiasis. Mechanical removal and systemic antiparasitic drugs are possible treatments for myiasis. However, prevention that includes wound cleaning and dressing is the best way to avoid this disease. CONCLUSIONS: Genital piercing can lead to potential complications and myiasis may occur when skin lesions are not properly treated.

Double inlay plus ventral onlay buccal mucosa graft for simultaneous penile and bulbar urethral stricture

ABSTRACT Objectives: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. Materials and Methods: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. Results: No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s. Conclusion: The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient's stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures.

An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

ABSTRACT Objective: The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC. Materials and Methods: The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision. Results: The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees. Conclusion: Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.

Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report / Silicone líquido utilizado com finalidade estética como potencializador da ocorrência de linfedema genital pós-radioterapia: relato de caso

ABSTRACT CONTEXT: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

RESUMO CONTEXTO: O linfedema consiste de retenção de fluido extracelular causada por obstrução linfática. Nas formas crônicas, observa-se acúmulo de tecido adiposo e fibrose. O linfedema genital é uma doença rara em países desenvolvidos e pode ter etiologia primária ou adquirida, em geral cursando com disfunções urinária e sexual, bem como com prejuízo do convívio social. O tratamento clínico é, em geral, pouco efetivo, indicando-se com frequência a abordagem cirúrgica, com excisão da área afetada. RELATO DE CASO: Relata-se o caso de paciente feminina transgênero, encaminhada para tratamento de linfedema genital crônico. Havia antecedente pessoal de tratamento de câncer de canal anal com radioterapia pélvica e de injeções de silicone líquido em glúteos e coxas com finalidade estética. Exames radiológicos mostraram tanto sinais de infiltração tecidual por silicone líquido como granulomas e linfadenopatia como de linfedema. Foi realizado o tratamento cirúrgico da área afetada, com excisão do tecido linfadenomatoso do escroto, preservando o pênis e testículos, com resultado satisfatório. A análise histopatológica mostrou achados compatíveis com infiltração tecidual por material exógeno, bem como com linfedema crônico. CONCLUSÃO: O linfedema genital pode ser causado pela associação de lesão por injeção de silicone líquido e radioterapia na região pélvica. As decisões no tratamento de neoplasias em pacientes previamente submetidos a injeção de silicone líquido devem levar em conta esse fato, já que pode representar fator de risco para complicações de tratamento radioterápico.

A wet dressing for male genital surgery: A phase II clinical trial

ABSTRACT Purpose: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. Methods: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. Results: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. Conclusion: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.

Epithelioid Hemangioendothelioma of Penis.

Epithelioid Hemangioendothelioma is a rare vascular tumor of low malignant potential most commonly found in the lung, liver and soft tissues. Penis is a very rare site for it. We report a case of penile epithelioid hemangioendothelioma. Surgery is the standard treatment and close clinical follow up is necessary due to its unpredictable natural history.

Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

Introduction Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier’s gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion Penile skin recovery following Fournier’s gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall. .

Chordee without hypospadias: operative classification and its management

Developing countries. To propose a operative classification of Chordee without hypospadias [CWH] with its management. Tertiary referral centre; Retrospective study from January 2000 to January 2011. Total 26 patients were classified peroperatively into sixtypes [A: Cutaneous chordee[rightwards arrow] Degloving skin and dartos [1/26]; B: Fibrous chordee[rightwards arrow] chordectomy [4/26];C: Corporocavernosalchordee[rightwards arrow] Corporoplasty +/- Urethral mobilization [4/26]; D: Urethral tethering with Hypoplastic urethra[rightwards arrow]Urethral mobilization +/- urethral reconstruction because of hypoplastic urethra [14/26]; E: Congenital short urethra[rightwards arrow] excision of urethra from the meatus and urethroplasty [2/26]; and F: Complex chordee[rightwards arrow] Degloving +/- Corporoplasty +/- urethroplasty [1/26 patients].The follow-up over 6 months to 9 years were analyzed. SPSS soft ware version 17.0 for Windows. The mean age of surgery was 5.33 +/- ?0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% [7/26] [including 7.7% [3/26] of associated metal stenosis]. The urethral stricture developed in 3.8% [1/26]. CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69 percent) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53 percent) cases, it was totally attached to the testis in 54 (37.76 percent) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Membrana e fusão penescrotal / Webbed pênis and penoscrotal fusion

Membrana penescrotal ou fusão penescrotal na forma isolada é uma rara anomalia de etiologia obscura, na qual a pele do pênis e o escroto estão fundidos. A fusão pode ser completa, com total ausência de angulação do pênis e escroto, ou incompleta, com uma membrana de extensão variável ligando o pênis proximal ao escroto. O objetivo da correção cirúrgica é separar o pênis do escroto, o que poderá ser realizado facilmente, utilizando-se plástica com retalhos em ?Z?, plásticas com retalhos ?V-Y?, ou incisão transversal e sutura vertical. Os resultados com a correção precoce são mais gratificantes e auxiliam a prevenir vários problemas psíquicos.

Torção peniana / Penile torsion

A torção peniana congenital, constituindo-se em uma anomalia isolada, é uma relevante malformação, que ultimamente tem aumentado a frequência em publicações. Caracteriza-se pela rotação da rafe mediana em espiral e quase sempre segue a direção para a esquerda. Se a rotação é moderada, quando tem menos de 90 graus de rotação, não apresenta sintomas nem dificulta a ereção. Independente do grau de rotação e da idade, e dentro do contexto psicossocial, a correção cirúrgica está indicada. Quando estiver associada à fimose e outras afecções, o tratamento ideal é desfazer a rotação no ato da circuncisão. Far-se-á a retração da pele até a base do órgão, a seguir desfazendo a rotação e finalizando igualmente a circuncisão.

Plastia peneana con malla surgisis ® para la corrección de la enfermedad de Peyronie / Correction of Peyronie's disease using surgisis ® mesh

Introducción: La enfermedad de Peyronie (EP) consiste en la formación de una o varias placas fibrosas en el tejido conjuntivo de la albugínea peneana. Esta alteración puede generar una erección curva de grado variable, a menudo dolorosa, ocasionando gran impacto en la calidad de vida. Se reporta una prevalencia entre 3 por ciento a 9 por ciento, pero estudios más recientes la triplican. Se han descrito variados factores de riesgo involucrados, publicándose diversos tratamientos médicos y quirúrgicos, entre los que destacan plicaturas, colocación de prótesis, injertos autólogos, uso de matriz extracelular de tejidos(MECT) o combinación de éstos. Presentamos nuestra experiencia con el uso de MECT de submucosa bovina (Surgisis®) en pacientes portadores de EP, analizando la morbilidad posoperatoria, los resultados estéticos y funcionales en una serie consecutiva de pacientes con seguimiento estricto. Pacientes y método: Desde octubre de 2007 a enero de 2009, 12 pacientes con placas indoloras mayores a 3 cms, medidas por ultrasonografía y curvaturas dorsales mayores a 35°, fueron sometidos, previo consentimiento informado, a una plastia peneana utilizando malla Surgisis®, sin resecar la placa. Todos recibieron 1 gr diario de vitamina E seis meses previos a su intervención. Se excluyeron pacientes con disfunción eréctil severa. Bajo profilaxis con cefazolina, se disecó circunferencialmente hasta la albugínea, liberando el complejo dorsal para identificar y seccionar la placa. El tamaño de la malla fue 30 por ciento mayor al lecho a reparar. Se analizaron atributos personales, resultados quirúrgicos, índice de satisfacción (escala 0 a 10) y seguimiento posintervención (SPSS 15.0, Microsoft®).Resultados: La edad promedio fue de 54 años (45-68). Tiempo promedio quirúrgico: 56 minutos (37-75). El período de hospitalización fue de 1,5 días (1-3). El total de los pacientes de la serie corrigió su curvatura, reportando un índice de satisfacción estético y funcional...

Introduction: Peyronie’s disease (PD) is due to the development of one or several fibrous plaques in the penile albuginia. This alteration may generate an often painful bent erection causing an impact in the quality of life. A prevalence between 3 percent and 9percent has been reported; recent studies triplicate that figure. Different medical and surgical procedures have been described. Among them, plicatures, prosthesis, implants, autologous grafts, use of extracellular tissue matrix (ETM) or a combination of them. We present our experience with ETM from bovine submucosa (Surgisis®) in patients with PD. We described postoperative morbidity, esthetic and functional results in a consecutive series of patients with close follow up. Patients and method: After obtaining informed consent, from October 2007 to January 2009, 12 patients with painless plaques measuring more that 3 cm and dorsal curvature over 35∞, underwent penileplasty with Surgisis® mesh. The plaque was not resected. Before surgery, all patients received 1 gram of Vitamin E daily for six months. Patients with severe erectile disfunction were excluded. During surgery, prophylaxis with Cefazoline was used. A circumferential dissection up to the albuginea was done. The dorsal complex was freed and the plaque was identified and sectioned. The size of the mesh was 30 percent larger than the area to be repaired. We recorded personal data, surgical results, satisfaction index (from 0 to 10) and follow up (SPSS 15.0 Microsoft®).Results: Average age was 54 (45-68). Average surgical time was 56 minutes (37-75). Hospital stay was 1.5 days (1-3). All patients corrected the curvature reporting a satisfaction index over 85 percent. Average follow up was 14 month (7-22). There were no complications. Conclusion: The use of bovine submucosa appears as an excellent procedure for the treatment of PD. The technique is simple and effective with low morbidity, good tolerance and safety.

Penile torsion correction by diagonal corporal plication sutures

Penile torsion is commonly encountered. It can be caused by skin and dartos adherence or Buck’s fascia attachments. The authors suggest a new surgical approach to solve both problems. If Buck’s fascia involvement is demonstrated by artificial erection then a new diagonal corporal plication suture is described to effectively solve this problem.

Frenulectomía peneana con láser CO2 en hombres con lesiones por virus papiloma humano / Dioxide laser penis frenulectomy in men with human papiloma virus infection

El dióxido de carbono (CO2) presenta ventajas sobre la cirugía convencional. No se hanencontrado estudios de frenulectomía en pacientes con virus papiloma humano (HPV) con láser u otras técnicasquirúrgicas. Objetivos: Dar a conocer la técnica de la frenulectomía, valorar la eficacia del láser de CO2, evaluarposibles complicaciones, apreciar sus ventajas. Materiales y Métodos: Estudio cuantitativo descriptivo transver-sal. Variables de estudio: Tiempo operatorio, sangrado intraoperatorio, tiempo de internación post operatoria, com-plicaciones post operatorias, tiempo de cicatrización. Universo de estudio: 55 hombres de 17 a 63 años con lesionespor HPV en pene, entre octubre de 2006 a julio de 2008. Muestra: 53 pacientes. Resultados: En el estudio 19%tenían 24 años, 18% 19 años, 17% 21 años (Media: 24,62). En 61% de los pacientes la intervención duró 1,5 minutos(media 1,8). Solo el 2% experimentó sangrado intraoperatorio. Complicaciones post operatorias: sangrado en el 2%y dolor a la erección en el 4%. 38% de los pacientes tardó 15 días en cicatrizar (media: 13,62). Conclusiones:Frenulectomía láser con CO2 es eficaz por su reducido tiempo operatorio, escasas complicaciones y por serambulatoria.

Carbon dioxide (CO2) has advantages over conventional surgery. No studies were found aboutfrenulectomy with laser or other surgical techniques in patients with human papillomavirus (HPV). Objectives: toshow the frenulectomy technique, to determine the effectiveness of CO2 laser surgery, evaluate complications,appreciate its advantages. Material and Methods: A descriptive cross-sectional quantitative study. Study variables:operative time, intraoperative bleeding, postoperative hospitalization time, postoperative complications, healing time.Universe study: 55 men from 17 to 63 years with HPV lesions in penis, from October 2006 to July 2008. Results: In thestudy 19% were 24 years, 18% 19 years, 17% 21 years (mean: 24.62). In 61% of patients the operation lasted 1.5minutes (mean 1.8). Only 2% experienced intraoperative bleeding. Postoperative complications: bleeding in 2% andpain on erection in 4%. 38% of patients took 15 days to heal, (mean: 13.62). Conclusions: Frenulectomy with CO2laser is effective, because it reduced operating time, few complications and it ́s ambulatory.

Penile myiasis as a differential diagnosis for genital ulcer: a case report

The genital localized myiasis is a rare zooparasitic dermatosis. This case reported to a penile myiasis by Dermatobia hominis larvae in a 62 year-old man, who is a retired military official from São Gonçalo city, Rio de Janeiro state, Brazil. This patient was guided to the sexually transmitted diseases (STD) clinic from Universidade Federal Fluminense (UFF) by professionals from a urology outpatient clinic of a public hospital from Rio de Janeiro state. The exam showed a 2 cm diameter nodular lesion with a hyperemic area in the glands penis that had arisen 20 days before the exam. It evolved in a favorable way after larvae removal, through previous local anesthesia and slight pressure in lesion's base with the extraction of the larvae. Penile myiasis is not a very frequent situation, although it must be considered as an option in differential diagnosis of genital infectious diseases, even among people of low economical level, as in the case presented.

Experience with the surgical management of fracture penis

To know the etiology, complications and outcome of surgical management of fracture penis. This descriptive study carried out in the surgical departments of Lady Reading Hospital Peshawar from April 2000 to March 2005. Patients with the clinical diagnosis of fracture penis were admitted and operated. All patients except those with haematuria were catheterized. Most of these patients were explored via a circumcoronal incision and the defect in the tunica of corpus cavernosum repaired with 3/0-vicryl suture. No drain was used and a light compression dressing was done in all patients. Catheter was removed on the second postoperative day. Follow up was arranged at 6 and 24 months of operation. During the study period 51 patients were operated for fracture penis. Mean age at presentation was 32 years. The commonest cause of fracture penis was manual fiddling with the organ to overcome an erection [39.2%]. The incidence of associated urethral injury was 1.96% [n=1/51]. The commonest mode of presentation was with a cracking sound, local pain and immediate detumescence [90%, 98% and 94% respectively]. Average hospital stay was 3.4 days. Immediate postoperative complication was urinary retention in 2 patients [3.92%]. Long-term complications were negligible. There was only one readmission at 6 months for urethral stricture that responded well to optical urethrotomy. The commonest cause of fracture penis is manual manipulation to overcome an erection. The best treatment option is immediate surgical repair