Delaying Surgical Treatment of Penile Fracture Results in Poor Functional Outcomes: Results from a Large Retrospective Multicenter European Study

Background: Penile fracture is a rare clinical entity that represents a urologic emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. Objective: To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients to investigate the impact of surgical delay on functional outcomes. Design, setting, and participants: A retrospective analysis was performed using data obtained from 137 patients presenting with penile fracture at seven different European academic medical centers between 1996 and 2013. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect, and surgical technique were recorded. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. Outcome measurements and statistical analysis: The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. Results and limitations: The median age of the patients was 34.50 yr (interquartile range [IQR]: 28.0–46.5 yr). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound, and 5 patients (3.64%) were evaluated with magnetic resonance imaging. All patients were treated surgically, and the duration between emergency room admission and surgical intervention was 5.0 h (IQR: 3.6–8.0 h). The median length of tunica albuginea defect was 10 mm (IQR: 8–20 mm). Postoperative IIEF-5 scores were 21 (IQR: 12–23) and 23 (IQR: 15–24) at the first and third postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed >8.23 hours after emergency room admission, postoperative erectile function was significantly worse (p = 0.0051 at first month and p = 0.0057 at third month postoperatively). Conclusions: Our multicenter study showed that delaying surgical intervention results in significantly impaired erectile function. Surgical treatment must be planned as soon as possible to avoid postoperative erectile dysfunction. Patient summary: We looked at sexual outcomes following the repair of penile fracture in a large European population. We found that outcomes worsened if surgical repair was delayed. Early surgical repair of penile fracture is associated with better outcomes for erectile function in patients with penile fracture. Delaying surgical intervention results in significantly decreased erectile function.