Penile fracture surgery12/3/2023 ![]() ![]() , who report that as well as gross haematuria, microscopic haematuria is an indicative sign in 50% of cases. This percentage is far less than reported in earlier studies of up to 30% but there is no consensus with regard to the role for urethrography with 12 of 21 authors who commented on urethral injury recommending its use when suspected clinically and others finding its use unnecessary. This implies this sign, along with blood at the meatus and urinary symptoms is highly indicative of urethral rupture. Meta-analysis showed that urethral bleeding was seen in 5.6% of cases, whereas confirmed urethral injury was present in just under 6.1% of patients. The most frequent signs on examination were swelling (43%) and discoloration (33%), in keeping with the typical aubergine sign/eggplant deformity on presentation. The rare nature of penile fracture does not lend itself to a prospective trial therefore, this study aims at systematically reviewing the literature to meta-analyse where possible and to summarise the best of current worldwide practises to thus inform the optimal management modality. ![]() Importantly, while numerous studies have reported their management of penile fractures, their cohorts are small making it challenging to generalise regarding the optimal treatment approach. Historically, penile fracture was managed conservatively, but owing to a relatively high morbidity of up to 30% (erectile dysfunction (ED), plaques, painful erections, curvature and infected haematomas) contemporary management has shown a trend towards following urgent surgical exploration and repair of the tunical defect. The classic patient gives a history of hearing a cracking noise during sexual activity when the tunica ruptures, rapidly followed by pain, detumescence, and a substantial subcutaneous haematoma leading to an ‘eggplant deformity'. ![]() The most prevalent example of this practise (also known as ‘Taqnaadan') is one Iranian study where 269 of 352 (76%) patients suffered a penile fracture in the process. In some Middle Eastern countries, many reported cases are due to patients ‘kneading and snapping' the erect penis to achieve rapid detumescence in unsuitable situations. Analysing the literature would seem to suggest a geographical variation in the aetiology of penile fracture. A widely held view is that the ‘woman on top' position poses the greatest risk to penile fracture although no systematic review has corroborated this. Other causes include rolling over in bed on to the erect penis, forced flexion to achieve detumescence and external blunt trauma. It is defined as the traumatic rupture of the tunica albuginea of the corpora cavernosum common culprits are intercourse when the penis strikes the perineum or masturbation. Penile fracture is an uncommon presentation to Urology departments with an incidence of 1 in 175,000. The combined outcome of rapid diagnosis by history and clinical examination and swift surgical intervention is key for reconstruction with minimal long-term complications. Discussion: Early surgical intervention is associated with significantly fewer complications than conservative management or delayed surgery. Meta-analysis shows that overall early surgery is preferable to delayed surgery but that rates of ED are not significantly different. There was no significant difference in the number of patients developing plaques/nodules (p = 0.94). Surgical intervention results in significantly less erectile dysfunction (ED), curvature and painful erection than conservative management. Meta-analysis shows that surgical intervention was associated with significantly fewer complications vs. Results: A total of 58 relevant studies involving 3,213 patients demonstrated that intercourse accounts for only 48% of cases with masturbation and forced flexion accounting for 39%. Data was collated and where possible meta-analysed using Revman software. Outcomes measures were numbers of patients receiving surgical or conservative management, aetiology of fracture, length of admission, complications as well as the specifics of diagnostic approaches and operative management. Full texts of relevant articles were obtained and screened according to the inclusion criteria. Methods: A search of all reported literature was conducted for all articles reporting on the management and outcomes of penile fractures. Objectives: To review the causes and management of penile fracture and to compare between surgical and conservative management as well as immediate and delayed interventions in terms of overall and specific complications. ![]()
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