Penile fracture refers to the traumatic rupture of the tunica albuginea and the corpora cavernosa of the penis. It is a rare condition that results from traumatic bending of the erect penis, typically during sexual intercourse or masturbation. Penile fractures usually present with acute pain and a cracking sound, accompanied by immediate loss of erection, as well as curving, swelling, and hematoma of the penis. In most cases, the diagnosis is established clinically, but imaging methods (e.g., ultrasound, MRI) may be needed in ambiguous cases. Retrograde urethrography is recommended in all cases of confirmed penile fracture to rule out concomitant urethral damage. Penile fracture is an acute urological emergency and requires immediate surgical treatment to avoid long-term complications, including abnormal curvature of the penis and erectile dysfunction.
- Traumatic rupture of the tunica albuginea and one or both of the corpora cavernosa of the erect penis
Traumatic bending of the erect penis
- During sexual intercourse; most commonly occurs with the penetrative partner on top
- Aggressive masturbation methods
- Cracking, snapping, or popping sound caused by rupturing of the tunica albuginea and soft tissue
- Immediate detumescence (loss of erection)
- Pain; varies in intensity depending on severity of the injury
- Pronounced soft tissue swelling, curving, and hematoma of the penis (“eggplant” appearance)
- Blood at the urethral meatus, urinary retention, and/or gross hematuria in concomitant urethral injury
The diagnosis of penile fractures is primarily clinical. Additional imaging is performed to diagnose ambiguous cases.
- Retrograde urethrography: performed if urethral injury is suspected before insertion of a transurethral indwelling catheter
The differential diagnoses listed here are not exhaustive.
- Surgical procedure
- Pain medication; prophylactic oral antibiotics
- Light compression dressing
- 4 weeks of sexual abstinence (suppression of spontaneous erections with diazepam or stilboestrol may be considered)
- Follow-up with retrograde urethrography in patients with urethral reconstruction upon removal of the urethral catheter after 2 weeks
Penile fracture is a urological emergency and requires immediate surgical treatment to restore functionality and minimize risk of long-term complications!
We list the most important complications. The selection is not exhaustive.