Penile Fracture: Abuse of Erect Penis, Concomitant Urethral Injuries and Outcome of Surgical Management- A Case Series

Abstract

The erect penis can be fractured by blunt trauma, commonly vigorous sexual intercourse or forced flexion. Forced flexion is a self-inflicted  or self-abused injury, and concomitant urethral injury is reflective of the application of excessive force to the organ. We aim to  describe the aetiology and concomitant urethral injuries corroborative of these observations and the outcome of surgical management in  our institution.18 consecutive patients with Penile Fractures managed by the Urology Department of our institution over 14 years  (-2008-2021) were retrospectively studied for demographic characteristics, time to presentation, etiologic mechanism, clinical features,  surgical technique, findings at exploration and complications. All patients underwent immediate surgical exploration and repair. The  mean age of the patients and time to presentation were 35±9.2 years and 124.4±200.6 hours, respectively. 38% (7) of injuries were self- inflicted(taaqhandan) while one (5.5%) was caused by partner abuse. Concomitant urethral injuries occurred in 44.3% of patients (33.1% and 11.2% for the sexual and nonsexual groups, respectively). Three patients (16.5%) demonstrated tricorporeal fractures; one (5.5%) of  these resulted from forced flexion (self-abuse). 94.4% (17) of patients reported satisfactory voiding and erectile functions in the follow-up  period. Vigorous sexual intercourse, partner and self-abuse resulted in severe penile fractures, with high percentage of concomitant  urethral injuries, describable as, “Abuse of the erect penis.” Immediate surgical repair demonstrated fewer complications and excellent  functional outcomes.