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Surgical reconstruction for penile fracture: a systematic review

International Journal of Impotence Research volume 32, pages 75–80 (2020)Cite this article

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Abstract

Penile fracture is a rare condition that describes the rupture of the corpus cavernosum following direct, high-pressure trauma to the erect penis. There is no standardized management algorithm for these patients. We performed a systematic review of the past 10 years regarding management of penile fractures. A complete PRISMA-P 2015 checklist was performed where we reviewed English articles published over the past 10 years to identify 105 articles, where 63 articles were of relevance and subsequently narrowed to a total of 28 articles into the final review for this study. We determined that immediate penile exploration and tunica repair is considered the most common and current management of penile fractures with experts demonstrating that it leads to the fastest in recovery in erectile function and positive cosmetic outcomes. However, we also determined that the specific algorithm can be variable—down to the suture material, use of catheterization, urethroplasty when involved, and length of recovery/follow-up. In the last several decades, men with penile fracture have been treated, in most cases, with immediate surgical intervention. This review highlights the varying practices regarding surgical exploration, injury repair, and postoperative management in men with a penile fracture. Immediate penile exploration and tunica repair have been the mainstay approach of management.

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References

  1. Mydlo JH. Surgeon experience with penile fracture. J Urol. 2001;166:526–8. Discussion 8–9.

    Article  CAS  PubMed  Google Scholar 

  2. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med. 2009;6:1141–50.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Ateyah A, Mostafa T, Nasser TA, Shaeer O, Hadi AA, Al-Gabbar MA. Penile fracture: surgical repair and late effects on erectile function. J Sex Med. 2008;5:1496–502.

    Article  PubMed  Google Scholar 

  5. Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional injection of collagenase Clostridium histolyticum may increase the risk of late-onset penile fracture. Sex Med Rev. 2018;6:272–8.

    Article  PubMed  Google Scholar 

  6. Amer T, Wilson R, Chlosta P, AlBuheissi S, Qazi H, Fraser M, et al. Penile fracture: a meta-analysis. Urol Int. 2016;96:315–29.

    Article  PubMed  Google Scholar 

  7. Hassali MA, Nouri AI, Hamzah AA, Verma AK. Role of penile doppler as a diagnostic tool in penile fracture. J Med Ultrasound. 2018;26:48–51.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mydlo JH, Hayyeri M, Macchia RJ. Urethrography and cavernosography imaging in a small series of penile fractures: a comparison with surgical findings. Urology. 1998;51:616–9.

    Article  CAS  PubMed  Google Scholar 

  9. Saglam E, Tarhan F, Hamarat MB, Can U, Coskun A, Camur E, et al. Efficacy of magnetic resonance imaging for diagnosis of penile fracture: a controlled study. Investig Clin Urol. 2017;58:255–60.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kitrey ND, Djakovic N, Hallscheidt P, Kuehhas FE, Lumen N, Serafetinidis E, et al. EAU Guidelines on Urological Trauma. EAU Guidelines presented at the EAU Annual Congress Copenhagen 2018.

  11. Malis J. Zur Kausuistik der fractura penis. Arch Klin Chir. 1924;129:651.

  12. Gross M, Arnold TL, Waterhouse K. Fracture of the penis: rationale of surgical management. J Urol. 1971;106:708–10.

    Article  CAS  PubMed  Google Scholar 

  13. Ozorak A, Hoscan MB, Oksay T, Guzel A, Kosar A. Management and outcomes of penile fracture: 10 years’ experience from a tertiary care center. Int Urol Nephrol. 2014;46:519–22.

    Article  PubMed  Google Scholar 

  14. Yamacake KG, Tavares A, Padovani GP, Guglielmetti GB, Cury J, Srougi M. Long-term treatment outcomes between surgical correction and conservative management for penile fracture: retrospective analysis. Korean J Urol. 2013;54:472–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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  PubMed  Google Scholar 

  16. Bali RS, Rashid A, Mushtaque M, Nabi S, Thakur SA, Bhat RA. Penile fracture: experience from a third world country. Adv Urol. 2013;2013:708362.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gamal WM, Osman MM, Hammady A, Aldahshoury MZ, Hussein MM, Saleem M. Penile fracture: long-term results of surgical and conservative management. J Trauma. 2011;71:491–3.

    Article  PubMed  Google Scholar 

  18. 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 

  19. Khan ZI. Management of penile fracture and its outcome. J Coll Physicians Surg Pak. 2013;23:802–5.

    PubMed  Google Scholar 

  20. Kozacioglu Z, Degirmenci T, Arslan M, Yuksel MB, Gunlusoy B, Minareci S. Long-term significance of the number of hours until surgical repair of penile fractures. Urol Int. 2011;87:75–9.

    Article  PubMed  Google Scholar 

  21. Kozacioglu Z, Ceylan Y, Aydogdu O, Bolat D, Gunlusoy B, Minareci S. An update of penile fractures: long-term significance of the number of hours elapsed till surgical repair on long-term outcomes. Turk J Urol. 2017;43:25–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Moreno Sierra J, Garde Garcia H, Fernandez Perez C, Galante Romo I, Chavez Roa C, Senovilla Perez JL, et al. Surgical repair and analysis of penile fracture complications. Urol Int. 2011;86:439–43.

    Article  PubMed  Google Scholar 

  23. Reis LO, Cartapatti M, Marmiroli R, de Oliveira Junior EJ, Saade RD, Fregonesi A. Mechanisms predisposing penile fracture and long-term outcomes on erectile and voiding functions. Adv Urol. 2014;2014:768158.

    PubMed  PubMed Central  Google Scholar 

  24. El-Assmy A, El-Tholoth HS, Mohsen T, Ibrahiem el HI. Long-term outcome of surgical treatment of penile fracture complicated by urethral rupture. J Sex Med. 2010;7:3784–8.

    Article  PubMed  Google Scholar 

  25. Al Ansari A, Talib RA, Shamsodini A, Hayati A, Canguven O, Al Naimi A. Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review. Int J Impot Res. 2013;25:221–3.

    Article  CAS  PubMed  Google Scholar 

  26. El-Assmy A, El-Tholoth HS, Abou-El-Ghar ME, Mohsen T, Ibrahiem EH. Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture. Int J Impot Res. 2012;24:20–5.

    Article  CAS  PubMed  Google Scholar 

  27. Gedik A, Kayan D, Yamis S, Yilmaz Y, Bircan K. The diagnosis and treatment of penile fracture: our 19-year experience. Ulus Travma Acids Cerrahi Derg. 2011;17:57–60.

    Article  Google Scholar 

  28. Hatzichristodoulou G, Dorstewitz A, Gschwend JE, Herkommer K, Zantl N. Surgical management of penile fracture and long-term outcome on erectile function and voiding. J Sex Med. 2013;10:1424–30.

    Article  PubMed  Google Scholar 

  29. Swanson DE, Polackwich AS, Helfand BT, Masson P, Hwong J, Dugi DD 3rd, et al. Penile fracture: outcomes of early surgical intervention. Urology. 2014;84:1117–21.

    Article  PubMed  Google Scholar 

  30. Tijani KH, Ogo CN, Ojewola RW, Akanmu NO. Increase in fracture of the penis in south-west Nigeria. Arab J Urol. 2012;10:440–4.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zare Mehrjardi M, Darabi M, Bagheri SM, Kamali K, Bijan B. The role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair. Int Urol Nephrol. 2017;49:937–45.

    Article  PubMed  Google Scholar 

  32. Hoag NA, Hennessey K, So A. Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review. Can Urological Assoc J. 2011;5:E23–6.

    Article  Google Scholar 

  33. Ekeke ON, Eke N. Fracture of the penis in the Niger delta region of Nigeria. J West Afr Coll Surg. 2014;4:1–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Sokolakis I, Schubert T, Oelschlaeger M, Krebs M, Gschwend JE, Holzapfel K, et al. The role of magnetic resonance imaging in the diagnosis of penile fracture in real-life emergency settings: comparative analysis with intraoperative findings. J Urol. 2019. 101097JU0000000000000211.

  35. Nawaz H, Khan M, Tareen FM, Khan S. Penile fracture: presentation and management. J Coll Physicians Surg Pak. 2010;20:331–4.

    PubMed  Google Scholar 

  36. Penbegul N, Bez Y, Atar M, Bozkurt Y, Sancaktutar AA, Soylemez H, et al. No evidence of depression, anxiety, and sexual dysfunction following penile fracture. Int J Impot Res. 2012;24:26–30.

    Article  CAS  PubMed  Google Scholar 

  37. Rivas JG, Dorrego JM, Hernandez MM, Portella PF, Gonzalez SP, Valle JA, et al. Traumatic rupture of the corpus cavernosum: surgical management and clinical outcomes. A 30 years review. Cent Eur J Urol. 2014;67:88–92.

    Google Scholar 

  38. Moslemi MK. Evaluation of epidemiology, concomitant urethral disruption and seasonal variation of penile fracture: a report of 86 cases. Can Urol Assoc J. 2013;7:E572–5.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nason GJ, McGuire BB, Liddy S, Looney A, Lennon GM, Mulvin DW, et al. Sexual function outcomes following fracture of the penis. Can Urol Assoc J. 2013;7:252–7.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Aderounmu AO, Salako AA, Olatoke SA, Eziyi AK, Agodinrin O. Penile fracture at LAUTECH Teaching Hospital, Osogbo. Niger J Clin Pr. 2009;12:330–2.

    CAS  Google Scholar 

  41. De Stefani S, Stubinski R, Ferneti F, Simonato A, Carmignani G. Penile fracture and associated urethral injury. Sci World J. 2004;4:92–9.

    Article  Google Scholar 

  42. Fergany AF, Angermeier KW, Montague DK. Review of Cleveland clinic experience with penile fracture. Urology. 1999;54:352–5.

    Article  CAS  PubMed  Google Scholar 

  43. Zargooshi J. Penile fracture in Kermanshah, Iran: report of 172 cases. J Urol. 2000;164:364–6.

    Article  CAS  PubMed  Google Scholar 

  44. Phillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. Andrology. 2015;3:632–6.

    Article  PubMed  Google Scholar 

  45. Barros R, Schul A, Ornellas P, Koifman L, Favorito LA. Impact of surgical treatment of penile fracture on sexual function. Urology. 2018;126:128–33.

    Article  PubMed  Google Scholar 

  46. De Luca F, Garaffa G, Falcone M, Raheem A, Zacharakis E, Shabbir M, et al. Functional outcomes following immediate repair of penile fracture: a tertiary referral centre experience with 76 consecutive patients. Scand J Urol. 2017;51:170–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Hal Kominsky, Sarah Beebe, Nayan Shah & Lawrence C. Jenkins

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  1. Hal Kominsky
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Correspondence to Lawrence C. Jenkins.

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Kominsky, H., Beebe, S., Shah, N. et al. Surgical reconstruction for penile fracture: a systematic review. Int J Impot Res 32, 75–80 (2020). https://doi.org/10.1038/s41443-019-0212-1

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