Fracture of the penis: a radiological or clinical diagnosis? A case series and literature review

Introduction: Fracture of the penis is rare and needs a surgeon's attention for appropriate management. The exact role of diagnostic investigations has not been established. We studied the role of these investigations and the results of surgery. Case series: Seventeen patients with median age of 36 years (range, 25-72 years) presented to us between 2002 and 2007 with suspected fracture of the penis. The mode of injury was sexual intercourse (15 patients), masturbation (1 patient), and rolling over in bed (1 patient). The median time from injury to presentation was 10 hours (range, 1-144 hours). Clinical evaluation included patient history and examination for all patients, ultrasonography in 6 patients, retrograde urethrography in 6 patients, and magnetic resonance imaging in 1 patient. Fifteen patients underwent immediate surgical exploration, 1 patient was kept under observation, and 1 patient refused surgical exploration. Discussion: Patient history and clinical examination was highly sensitive and accurate in predicting a cavernosal tear, and retrograde urethrography was highly sensitive and accurate in detecting urethral injury. Ultrasonography was highly specific but not sensitive for detecting a cavernosal tear. Radiological investigations did not influence patient management in any the cases. On surgical exploration, 15 patients had cavernosal tears and 4 also had urethral injuries; all injuries were repaired successfully. One patient had a negative surgical exploration and was diagnosed as having a superficial dorsal vein rupture. One patient had a history suggestive of penile fracture but had a normal clinical examination and was kept under observation. At follow up in a mean of 7.5 months, no patient had erectile dysfunction or penile deformity. Conclusion: Further evaluation beyond taking a patient history and performing a clinical examination is not necessary in most cases for managing patients with suspected penile fracture. Retrograde urethrography may be omitted before surgical exploration, even in cases with suspected urethral injury. Early surgical repair is associated with a good outcome with minimal complications.