Penile fracture

Last updated: December 19, 2021

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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.

References:[1]

  • Traumatic bending of the erect penis
    • During sexual intercourse; most commonly occurs with the penetrative partner on top
    • Aggressive masturbation methods

References:[1][2]

References:[1][2]

The diagnosis of penile fractures is primarily clinical. Additional imaging is performed to diagnose ambiguous cases.

References:[1]

Peyronie disease

  • 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 [3]
  • Classification
    • Active phase
      • Acute or inflammatory phase
      • Characterized by progressive penile deformity and painful erection
    • Stable phase
      • Chronic phase
      • Characterized by the lack of progression of penile deformity and pain
  • Clinical features
    • Penile pain
    • Penile nodules/indurations on the affected side of the penis
    • Erectile dysfunction due to abnormal curvature of the penis
    • Possibly associated with psychological conditions; (e.g., anxiety, depression) [4]
  • Differential diagnosis
  • Treatment
    • Active phase: oral NSAIDs or oral pentoxifylline for 3 months
      • No symptomatic improvement: intralesional collagenase injections
      • Symptomatic improvement: observation or continuation of oral pentoxifylline for another 6 months
    • Stable phase
      • 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

References:[1]

The differential diagnoses listed here are not exhaustive.

  • Surgical procedure
  • Postoperative measures
    • 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!

References:[1][2][5]

References:[1]

We list the most important complications. The selection is not exhaustive.

  1. Santucci RA. Penile Fracture and Trauma. Penile Fracture and Trauma. New York, NY: WebMD. http://emedicine.medscape.com/article/456305-workup#c7. Updated: December 30, 2015. Accessed: February 15, 2017.
  2. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current management of penile fracture: An up-to-date systematic review. Sex Med Rev. 2018; 6 (2): p.253-260. doi: 10.1016/j.sxmr.2017.07.009 . | Open in Read by QxMD
  3. T F Lue. Peyronie's disease: an anatomically-based hypothesis and beyond. Int J Impot Res. 2002; 14 (5): p.411-413. doi: 10.1038/sj.ijir.3900876 . | Open in Read by QxMD
  4. Terrier JE, Nelson CJ. Psychological aspects of Peyronie's disease.. Translational andrology and urology. 2016; 5 (3): p.290-5. doi: 10.21037/tau.2016.05.14 . | Open in Read by QxMD
  5. Cummings JM. Urethral Trauma. Urethral Trauma. New York, NY: WebMD. http://emedicine.medscape.com/article/451797-treatment#d11. Updated: November 18, 2015. Accessed: February 15, 2017.

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