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.
- 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
- Definition: : fibroproliferative disorder that affects the tunica albuginea of the penis, causing abnormal curvature of the penis
- Pathogenesis: repeated penile microtrauma during sexual intercourse or athletic activity followed by abnormal wound healing → fibrous plaque formation 
- Clinical features
- Differential diagnosis
- Active phase: oral NSAIDs or oral pentoxifylline for 3 months
- Observation: patients with a mild penile curvature (< 30°) and no erectile dysfunction
- Intralesional collagenase injections: patients with penile curvature (> 30°) and/or erectile dysfunction
- Surgical repair: patients unresponsive to treatment, with severe penile deformity, and/or with extensive calcifications
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!