A penile fracture is a rare but serious injury that occurs when the fibrous casing of the penis, the tunica albuginea, ruptures. Despite its name, this injury does not involve a bone, as the penis contains no skeletal structures. It is a urological emergency requiring prompt medical care.
Understanding a Penile Fracture
The penis contains three main columns of spongy tissue: two corpora cavernosa located dorsally, and the corpus spongiosum positioned ventrally, which encases the urethra. During an erection, blood fills the corpora cavernosa, causing them to expand and become rigid. These erectile bodies are enveloped by a strong, fibrous sheath called the tunica albuginea.
The tunica albuginea is 2 millimeters thick in a flaccid state but thins to 0.25 to 0.5 millimeters when erect, making it less elastic and more susceptible to injury. A penile fracture occurs when sudden, blunt force is applied to an erect penis, causing this thinned tunica albuginea to tear. This trauma commonly occurs during vigorous sexual intercourse, when the penis slips out of the vagina and strikes the perineum or pelvic bone. Other causes include aggressive masturbation or accidental impacts.
Recognizing the Signs
A penile fracture presents with distinct symptoms immediately after the injury. Individuals often report hearing a sudden “popping” or “cracking” sound at the moment of trauma, accompanied by immediate, severe pain.
An abrupt loss of erection, known as detumescence, follows the injury. The penis develops rapid swelling and extensive bruising due to blood leaking from the ruptured tunica albuginea, leading to a characteristic “eggplant deformity.” If the injury involves the urethra, symptoms may include blood at the urethral opening, blood in the urine, or difficulty urinating.
Immediate Medical Attention and Diagnosis
Immediate emergency medical attention for a suspected penile fracture is essential to prevent long-term complications. Prompt treatment can preserve penile length, erectile function, and the ability to urinate while standing. Delays in care can lead to lasting sexual dysfunction.
A doctor diagnoses a penile fracture based on the injury history and a physical examination. The characteristic “eggplant deformity” and a palpable defect in the tunica albuginea are strong indicators. While clinical findings are usually sufficient, imaging tests like ultrasound or MRI may be used if uncertain, to confirm the diagnosis, determine the tear’s extent, and assess for urethral involvement. A retrograde urethrogram is performed if a urethral injury is suspected.
Treatment Approaches
The primary treatment for a penile fracture is almost always surgical repair. The goal of the surgery is to evacuate the accumulated blood (hematoma) and repair the tear in the tunica albuginea. Studies generally recommend immediate surgical repair due to improved long-term outcomes compared to non-surgical management.
During the surgical procedure, an incision, often a circumferential degloving incision, is made to expose the penile shaft. The hematoma is then drained, and the tear in the tunica albuginea is identified. The edges of the torn tunica are freshened, and the tear is carefully closed with absorbable sutures in a watertight manner. In some cases, an artificial erection may be induced during surgery to confirm the repair is watertight and no further leakage occurs.
Recovery and Potential Outcomes
After surgical repair of a penile fracture, patients typically need to avoid sexual activity for several weeks to months, commonly 6-8 weeks, to allow for proper healing. Post-operative care involves pain management and activity restrictions. While immediate surgical intervention generally leads to good outcomes, some potential long-term complications can occur, particularly if treatment is delayed.
Possible long-term outcomes include penile curvature, also known as Peyronie’s disease, which can result from scar tissue formation. Erectile dysfunction is another potential complication, affecting a percentage of patients. Some individuals may experience painful erections or discomfort during intercourse. If the urethra was injured during the initial trauma, a urethral stricture, a narrowing of the urethra, may develop, potentially causing difficulty with urination. Additionally, patients may experience psychological impacts related to the injury and its effects on sexual function.