Immediate surgical repair of penile fracture:report of eight cases and review of the literature

ABSTRACT

Purpose: to evaluate prospectively the outcome of immediate surgical repair of penile fracture in eight cases. Patients and methods: Eight patients with penile fractures were evaluated by history taking and clinical examination to assess the extent of penile hematoma, the site of tear in the tunica albuginea and bleeding at urethral meatus. Their ages ranged between 22 and 46 years [mean 33.3 years]. All of them underwent immediate surgical exploration after fixation of urethral catheter using subcoronal circumferential incision with degloving of the penile skin. Penile hematoma was evacuated and tunical tear was repaired using absorbable interrupted suture [vicryl 3/0]. The degloved skin was returned back and sutured using chromic catgut 3/0. No drain was fixed and pressure bandage dressing was applied. Pen-operative broad spectrum antibiotics were given. Follow up period ranged from 6 to 8 months after repair. Penile fractures occurred due to vigorous sexual intercourse in 4 cases, rolling over in bed in 3 cases, and during masturbation in one patient. All patients had acute penile pain and swelling. The typical presentation of hearing snap sound was found in only one patient during masturbation. No urologic symptoms or urethral bleeding reported. The time elapsed between the occurrence of the fracture and presentation ranged from four to thirty six hours [mean 14.3 hours]. The site of tunical tear was palpated in 4 [50%] out of the eight cases. Tunical tear was in the right side in six cases [75%] and left side in two cases [25%]. Midshaft was injured in five cases and distal shaft was affected in three cases. All tears were unilateral and transverse and varied in length between 1.5 and 4 centimeters. Hospital stay after surgical repair ranged from 48 to 96 hours and patients were discharged from the hospital after removal of urethral catheter and bandages. Postoperative wound infection occurred in only one patient. However normal erectile function was regained in seven out of the eight cases. One patient developed erectile dysfunction. Diagnosis of penile fracture can be reached only by history taking and clinical examination. Early surgical interference with repair of tunical defect with absorbable sutures is advantageous with minimal morbidity