Introduction:
The penis is an organ in the male body without bones. Even in the absence of bones, the penis can undergo a fracture. This is caused due to the force applied to an erect penis during sexual intercourse. Direct trauma causes increased pressure in the cavernosal, which leads to the rupture of tunica albuginea. Penile fracture, if not treated, can also lead to anatomical dysfunction. If left untreated, the sexual health of the individual is hampered.
What Happens in a Penile Fracture?
The penis is boneless but can still fracture. Anatomically the penis consists of two columns or passages called corpora cavernosa and corpus cavernosum that get filled with blood during an erection. The corpora cavernosa and corpus cavernosum are covered by tunica albuginea. The tunica albuginea provides protection, but when a force is applied, it undergoes rupture, causing a fractured or broken penis.
Is Penile Fracture Common?
Penile fracture is common in middle-aged men between thirty to fifty years of age. Individuals affected are usually heterosexual males. Penile fractures are also seen in the MSM (men who have sex with men) population.
What Are the Symptoms of a Penile Fracture?
The symptoms involve:
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Cracking or popping sound while the fracture occurs.
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Intense pain that may or may not subside.
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Immediate softening of the penis during erection.
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Swelling and bruising due to accumulation of blood under the skin.
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Bleeding at the tip of the penis.
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Hematuria (blood in urine).
What Is the Cause of Penile Fracture?
The causes are:
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Penile fracture most of the time happens during sexual intercourse. The penis slips out of the partner and thrusts between the anus and the pelvic bone or the perineum creating pressure on the filled corpus cavernosa. Sexual positions such as female superior or rear entry have a higher incidence of penile fracture.
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Forceful or energetic masturbation.
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During an erection, the individual may hurt their penis by hitting a wall or door or rolling over the erect penis.
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Taqadaan is a practice performed by middle eastern or central Asian men where they bend an erect penis to change the size and shape of the penis or make an erection go away.
Physical Examination Findings:
Physical examination findings include:
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Angulated penis.
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Ecchymotic shaft (eggplant deformity is a clinical sign of a fractured penis).
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Asymmetric erection.
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Flaccid penis (soft and hanging loosely or penis which is at rest).
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Penis tenderness.
What Is the Differential Diagnosis for Penile Fracture?
The differential diagnosis involves:
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Dorsal vein rupture.
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Urethral tear.
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Penile contusion.
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Pelvic trauma.
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Coagulation disorders.
What Is the Evaluation and Diagnosis for Penile Fracture?
A thorough history of the case is taken to rule out conditions like dorsal penile vein injuries and nerve injuries. To check for tunica rupture, the healthcare provider may order the following imaging tests:
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Ultrasound detects irregular sites at cavernosa rupture.
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Magnetic resonance imaging (MRI) helps in diagnosis and perioperative management. MRI has a sensitivity and specificity rate of 100 % and 77.8 %, respectively.
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Retrograde urethrogram or cystoscopy (imaging test performed to check for urethral injury).
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Computed tomography (CT) provides the location and size of the injury.
During the examination for penile fracture, tests should be conducted to rule out urethral injury. Symptoms of urethral injury involve hematuria (blood in urine), blood in the urethral meatus, and difficulty voiding.
What Are the Complications of Penile Fracture?
The most common complication is sexual dysfunction. Individuals who experience penile fracture experience may be limited or have no sexual dysfunctions. Individuals may have postoperative sexual dysfunction, which may resolve after some time. In many cases, individuals with penile fractures may experience long-lasting sexual dysfunction. This may lead to mental health issues such as anxiety and depression in the affected individual. There are chances that the individual may change their sexual practices out of fear of a recurrent injury. A healthcare provider may advise counseling to cope with the postoperative period and sexual dysfunction. Surgical complications include:
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Curvature or curved penis.
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Erectile dysfunction (also called impotence, difficulty in having an erection).
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Painful erection.
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Loss of the length of the erect penis.
What Is the Treatment and Management for Penile Fracture?
The treatment of choice is prompt operative repair. Surgery is performed after evaluating the case and following all the case selection criteria. The surgery's main aim is to identify and repair tunica rupture. Linear incision or circumcision is used to open the skin. After opening the skin, the hematoma is removed. Removal of the hematoma gives direct visualization of the tunica defects. The tunica defect is repaired with an absorbable suture. The surgeon decides the suture type and suture material. The buck's fascia is repaired with a non-absorbable suture. A delay in the repair of penile fracture may result in significant changes in functional outcomes. According to a study, an eight-hour delay increased post-operative erectile dysfunction. Post-operative counseling should be provided to individuals to cope with it mentally.
What Is the Postoperative Care For Penile Fracture?
The individual is given post-operative instructions on the maintenance and care of the Foley catheter. The foley catheter is placed for four weeks to avoid any urethral injury. The clinical team gives wound care instructions for penile incisions. In addition, instructions are given on keeping the area clean and contaminant free. Shaving around the wounds or incisions should be strictly avoided, and refraining from sexual activity during the post-operative period.
How Long Is the Recovery Period?
Surgical procedures involve hospital admissions and may require admission even after the procedure, depending on the healthcare provider's advice. Instruction for follow-up visits may be given, which should be promptly followed to avoid complications.
What Is the Prognosis for Penile Fracture?
The prognosis for penile fracture surgery is good. However, if left untreated, the individual may experience the following:
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Problems while urinating.
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Not being able to have an erection.
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Curved or bent penis.
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Scar tissue formation.
Conclusion:
Penile fracture is a rare but severe injury that can affect sexual activity if left untreated. Even in the absence of bones, the penis can undergo a fracture. This is caused due to the force applied to an erect penis during sexual intercourse. Common in middle-aged men between thirty to fifty years of age. If left untreated can affect sexual activity and cause complications. Surgery is the treatment of choice, followed by counseling and postoperative follow-up.
