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Penile Fracture- A Sexual Urologic emergency

A penile fracture is a rare albeit troublesome sexual urologic emergency. I say ‘sexual’ as that is the most common cause is aggressive sexual intercourse. Usually a history of woman on top riding position is emphasized, though often times, the history is very vague due to the covert nature of the sexual activity which may involve an extramarital affair. Masturbation may very rarely be responsible.

The patient often hears a crack followed by rapid detumescence accompanied by swelling. The penis has an eggplant like deformity. It deviates to the opposite side of the fracture. These injuries can involve the urethra (urine tube) or the nerves sometimes. A detailed history and physical examination is enough to diagnose the condition.

Ultrasound and MRI are rarely employed. Surgical exploration is mandatory. Immediate attention required. Surgery gives optimal results if performed early. Repair of the penile sheath, evacuating the blood and repair of nerves and urine tube can be done concomitantly.

Complications like fibrous scarring of the penis, painful erections and erectile dysfunction may ensue if repair is not done to the penile sheath. A false penile fracture without the snap sound can be sometimes seen. This involves the collection of blood which may actually be a vascular problem instead of a fracture. These men may have erections in spite of blood collection and swelling.

The key in penile fracture is diagnosis and immediate treatment. Long term results are much better with immediate care. Delay is to be avoided diligently.

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