A penile fracture is a serious injury involving a rupture of the tunica albuginea, the strong, fibrous sheath that encases the erectile tissue within the penis. Despite its name, this injury does not involve a bone, as the penis contains no skeletal structures. This condition is a medical emergency requiring immediate attention to prevent long-term sexual and urinary problems.
Understanding a Penile Fracture
A penile fracture typically occurs when the erect penis experiences sudden trauma or forceful bending. This often happens during vigorous sexual intercourse, particularly in positions where the penis might slip out and strike against the partner’s pelvic bone or perineum. Other less common causes include aggressive masturbation or blunt trauma from accidents. During an erection, the tunica albuginea thins significantly, making it more susceptible to tearing.
Immediate signs and symptoms of a penile fracture include an audible popping or cracking sound at the moment of injury, followed by sudden and severe pain. The erection dissipates rapidly, a phenomenon known as detumescence. A significant hematoma, or collection of blood under the skin, quickly forms, leading to rapid swelling and discoloration of the penis, often described as an “eggplant deformity.” The penis may also appear bent or deviated. In some cases, blood may leak from the urethra or appear in the urine, indicating a possible urethral injury.
The Surgical Repair Process
Surgical intervention is the standard treatment for a penile fracture, performed as an emergency procedure to restore the integrity of the tunica albuginea and preserve erectile function. This surgery is usually conducted under general anesthesia. The goal is to repair the tear in the tunica albuginea, remove any accumulated blood clots, and address any associated injuries, such as to the urethra.
Surgeons use a circumferential incision to deglove the penile skin back to the base. This approach provides excellent exposure of the entire penis, allowing the surgeon to thoroughly inspect both corpora cavernosa (the main erectile bodies) and the corpus spongiosum (which contains the urethra). Once the tear in the tunica albuginea is located, the hematoma is evacuated, and the ruptured edges of the tunica are carefully brought together and repaired using absorbable sutures.
If the tear’s exact location is not immediately obvious, an ultrasound may be performed during the procedure to pinpoint the fracture site. An artificial erection can also be induced by injecting saline into the corpora cavernosa to confirm the repair is complete and there are no remaining leaks. If the urethra is also injured, it will be repaired during the same surgery. The aim is to restore the penis to its pre-injury state, prevent erectile dysfunction, maintain penile length, and allow normal urination.
Post-Surgery Recovery
Following penile fracture surgery, patients typically have a hospital stay ranging from one to three days. Pain management is addressed with prescribed painkillers to help alleviate discomfort. A bladder catheter is left in place for 24 to 48 hours and is removed before discharge; if the urethra was also injured, the catheter might remain for seven to ten days.
Light compressive dressings are applied to the penis for one week to help reduce swelling. Patients are advised on proper wound care. Swelling of the penis is expected and can last up to 10 days, gradually subsiding.
Rest is important, and patients should avoid strenuous activities. Patients must abstain from sexual intercourse for a minimum of six to eight weeks. Follow-up appointments with the surgeon are scheduled two weeks post-procedure to monitor healing and address any concerns.
Potential Outcomes and Considerations
Prompt surgical intervention for penile fractures leads to favorable outcomes, with high success rates in restoring erectile function. Studies indicate that immediate surgical repair results in significantly lower complication rates compared to conservative management. For instance, the incidence of erectile dysfunction (ED) after surgical repair is reported to be 0-12%, while conservative management can lead to ED rates as high as 22-62%.
Despite positive outcomes, some potential complications can arise. Erectile dysfunction, while less common with prompt surgery, can still occur in some patients, with rates varying from 0% to 17.4% in surgically treated cases. Penile curvature, also known as Peyronie’s disease, is another possible complication, reported in 12.1-15.3% of cases after surgery. This condition involves the formation of fibrous plaques that can cause a bend in the penis during erection.
Numbness or altered sensation in the penis is another less common outcome. Other potential issues include painful erections or the development of palpable nodules. The timing of surgery plays a role, as early intervention, ideally within 24 hours, is associated with better outcomes and a reduced risk of complications like painful intercourse or penile curvature. Patients are encouraged to communicate any persistent issues, such as pain, curvature, or changes in erectile function, with their healthcare provider for further evaluation and management.