Introduction: Penile fracture (PF) is a traumatic injury necessitating timely surgical intervention. This study examines the impact of an early vs delayed surgical intervention for PF on long-term erectile and urinary outcomes.
Methods: Patients who underwent surgical treatment for traumatic PF from March 2010 to October 2019 at our institution were evaluated to characterize demographics, surgical interventions and long-term outcomes. Non-traumatic PF patients were excluded. International Index of Erectile Function (IIEF-5) was utilized for objective post-operative erectile assessments.
Results: A total of 23 patients were evaluated with mean follow-up of 11.6 months. Mean age was 38.5 years and mean BMI was 28.6. No history of erectile dysfunction (ED) or Peyronie’s disease prior to trauma. Majority of patients 18/23 (78%) had surgical interventions within 24 hours (early repair), whereas 5/23 (22%) patients received surgical repair beyond 24hrs (delayed repair). In both groups, the preferred approach at the time of PF repair was the degloving incision 18/23 (78%) compared to ventral raphae incision 5/23 (22%). All patients underwent unilateral or bilateral corpora cavernosa repair of PF. Anastomotic urethroplasty for concomitant corpora spongiosum rupture was required in 6/23 patients. Although the most common complication after surgery was ED (62%), erectile function recovery after six months was 15/18 (83%) and 1/5 (20%) in the early vs delayed groups (p<0.05) (Table). 7 patients (3 in early and 4 in delayed groups) developed severe and persistent ED (IIEF-5: 5-7). 8 (17%) patients complained of post-operative penile curvature (6/18, 33% vs 2/5 40%). Deviation was <30° in all cases. One case of subjective penile shortening was reported in each group. In the delayed repair group, there was one each of reoperation for urethral stricture and transient priapism.
Conclusions: Early surgical repair of PF provides satisfactory long-term outcomes with adequate recovery of erectile and urinary functions. Majority of patients preserve erectile and urinary functions without the development of debilitating long-term sequalae. Large multi-institutional prospective follow-up would further elucidate the relationship between time to surgical intervention, aiding the surgical decision making. Source of