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Can the snapping sound discriminate true from false penile fractures? Bayesian analysis of a case series of consecutively treated penile fracture patients


Some patients with clinically diagnosed penile fracture actually have a false fracture (no tunica albuginea tear found at surgery). Although previous reports indicate that these patients often do not report hearing a snapping sound (henceforth sound) at injury, there are no studies of the sound’s role in this differential diagnosis. To assess if the sound’s absence increased the likelihood of intraoperatively diagnosing a false fracture, we retrospectively analyzed 65 consecutive clinically diagnosed penile fracture patients between January 2008 and December 2017, using surgical diagnosis of penile fracture as outcome variable and sound as main predictor, including as covariates age, presentation delay, immediate detumescence after injury, and whether injury occurred during sexual intercourse. Fifty-six patients had penile fracture (86.2%), and most (40, 71.4%) reported the sound, whereas two of the nine patients with false fracture reported the sound (22.2%, p = 0.007, Fisher’s exact test). Bayesian logistic regression revealed that the sound was associated with surgical diagnosis of penile fracture (relative odds ratio = 4.25), and the probability of penile fracture fell from 92 to 74% when the sound was not reported among patients injured during intercourse experiencing immediate detumescence. This study followed PROCESS (Preferred Reporting of Case Series in Surgery) guidelines.

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  1. 1.

    Morey AF, Zhao LC. Genital and lower urinary trauma. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell—Walsh urology. 11th ed. Philadelphia, PA: Elsevier; 2016; p. 2379–81.

  2. 2.

    Mirzazadeh M, Fallahkarkan M, Hosseini J. Penile fracture epidemiology, diagnosis and management in Iran: a narrative review. Transl Androl Urol. 2017;6:158–66.

    Article  Google Scholar 

  3. 3.

    Miller S, McAninch JW. Penile fracture and soft tissue injury. In: McAninch JW, editor. Traumatic and reconstructive urology. 1st ed. Philadelphia, PA: W. B. Saunders; 1996; p. 693–8.

  4. 4.

    Yapanoglu T, Aksoy Y, Adanur S, Kabadayi B, Ozturk G, Ozbey I. Seventeen years’ experience of penile fracture: conservative vs. surgical treatment. J Sex Med. 2009;6:2058–63.

    Article  Google Scholar 

  5. 5.

    Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotrauma: AUA guideline. J Urol. 2014;192:327–35.

    Article  Google Scholar 

  6. 6.

    Beysel M, Tekin A, Gürdal M, YücebaŞ E, Şengör F. Evaluation and treatment of penile fractures: accuracy of clinical diagnosis and the value of corpus cavernosography. Urology. 2002;60:492–6.

    Article  Google Scholar 

  7. 7.

    Feki W, Derouiche A, Belhaj K, Ouni A, Mouelhi SB, Slama MB, et al. False penile fracture: report of 16 cases. Int J Impot Res. 2007;19:471–3.

    CAS  Article  Google Scholar 

  8. 8.

    Bar-Yosef Y, Greenstein A, Beri A, Lidawi G, Matzkin H, Chen J. Dorsal vein injuries observed during penile exploration for suspected penile fracture. J Sex Med. 2007;4:1142–6.

  9. 9.

    Agarwal MM, Singh SK, Sharma DK, Ranjan P, Kumar S, Chandramohan V, et al. Fracture of the penis: a radiological or clinical diagnosis? A case series and literature review. Can J Urol. 2009;16:4568–75.

    PubMed  Google Scholar 

  10. 10.

    Koifman L, Barros R, Júnior RAS, Cavalcanti AG, Favorito LA. Penile fracture: diagnosis, treatment and outcomes of 150 patients. Urology 2010;76:1488–92.

    Article  Google Scholar 

  11. 11.

    El-Assmy A, El-Tholoth HS, Abou-El-Ghar ME, Mohsen T, Ibrahiem EHI. False penile fracture: value of different diagnostic approaches and long-term outcome of conservative and surgical management. Urology 2010;75:1353–6.

    Article  Google Scholar 

  12. 12.

    Kurkar A, Elderwy AA, Orabi H. False fracture of the penis: different pathology but similar clinical presentation and management. Urol Ann. 2014;6:23.

    Article  Google Scholar 

  13. 13.

    Mydlo JH. Surgeon experience with penile fracture. J Urol. 2001;166:526–9.

    CAS  Article  Google Scholar 

  14. 14.

    Pliskow RJ, Ohme RK. Corpus cavernosography in acute “fracture” of the penis. Am J Roentgenol. 1979;133:331–2.

    CAS  Article  Google Scholar 

  15. 15.

    Jack GS, Garraway I, Reznichek R, Rajfer J. Current treatment options for penile fractures. Rev Urol. 2004;6:114–20.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Dell’Atti L. The role of ultrasonography in the diagnosis and management of penile trauma. J Ultrasound. 2016;19:161–6.

    Article  Google Scholar 

  17. 17.

    Abolyosr A, Moneim AEA, Abdelatif AM, Abdalla MA, Imam HMK. The management of penile fracture based on clinical and magnetic resonance imaging findings. Br J Urol Int. 2005;96:373–7.

    Article  Google Scholar 

  18. 18.

    Guler I, Ödev K, Kalkan H, Simsek C, Keskin S, Kilinç M. The value of magnetic resonance imaging in the diagnosis of penile fracture. Int Braz J Urol. 2015;41:325–8.

    Article  Google Scholar 

  19. 19.

    Mydlo JH, Gershbein AB, Macchia RJ. Nonoperative treatment of patients with presumed penile fracture. J Urol. 2001;165:424–5.

    CAS  Article  Google Scholar 

  20. 20.

    Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current management of penile fracture: An up-to-date systematic review. Sex Med Rev. 2018;6:253–60.

  21. 21.

    Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP, et al. The PROCESS 2018 statement: Updating Consensus Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines. Int J Surg Lond Engl. 2018;60:279–82.

    Article  Google Scholar 

  22. 22.

    O’Hara RB, Sillanpää MJ. A review of Bayesian variable selection methods: what, how and which. Bayesian Anal. 2009;4:85–117.

    Article  Google Scholar 

  23. 23.

    Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Mak. 2006;26:565–74.

    Article  Google Scholar 

  24. 24.

    R Core Team. R: a language and environment for statistical computing. R foundation for statistical computing. 2018.

  25. 25.

    Plummer M. JAGS: a program for analysis of Bayesian graphical models using Gibbs sampling. 3rd International Workshop on Distributed Statistical Computing (DSC 2003); Vienna, Austria 124. 2003.

  26. 26.

    Brown M. rmda: Risk Model Decision Analysis. 2018.

  27. 27.

    Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez J-C, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform. 2011;12:77.

    Article  Google Scholar 

  28. 28.

    Shah DK, Paul EM, Meyersfield SA, Schoor RA. False fracture of the penis. Urology. 2003;61:1259.

    Article  Google Scholar 

  29. 29.

    MacKenzie DI. Occupancy estimation and modeling: inferring patterns and dynamics of species. 1st ed. Boston: Academic Press; 2006.

  30. 30.

    Uder M, Gohl D, Takahashi M, Derouet H, Defreyne L, Kramann B, et al. MRI of penile fracture: diagnosis and therapeutic follow-up. Eur Radiol. 2002;12:113–20.

    Article  Google Scholar 

  31. 31.

    Zhang Z, Hamagami F, Lijuan Wang L, Nesselroade JR, Grimm KJ. Bayesian analysis of longitudinal data using growth curve models. Int J Behav Dev. 2007;31:374–83.

    Article  Google Scholar 

  32. 32.

    Gelman A, Jakulin A, Pittau MG, Su Y-S. A weakly informative default prior distribution for logistic and other regression models. Ann Appl Stat. 2008;2:1360–83.

    Article  Google Scholar 

  33. 33.

    Agha RA, Fowler AJ, Rajmohan S, Barai I, Orgill DP, PROCESS Group. Preferred reporting of CasE series in surgery; the PROCESS guidelines. Int J Surg Lond Engl. 2016;36:319–23.

    Article  Google Scholar 

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Dr. Wallace Guedes Borges commented on an earlier version of this manuscript. Ms. Raquel Fernandes Carneiro assisted with the data collection. Mrs. Anna Maria Bouchardet da Fonseca Grebot revised the text for grammatical correctness.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Aderivaldo Cabral Dias-Filho.

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Dias-Filho, A.C., Fregonesi, A., Martinez, C.A.T. et al. Can the snapping sound discriminate true from false penile fractures? Bayesian analysis of a case series of consecutively treated penile fracture patients. Int J Impot Res 32, 446–454 (2020).

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