1 In accordance with the results we found, it is often reported by authors that the distal penile shaft is almost always convoluted in penile fractures. However, as found in the results shown above, no direct link was seen between etiology of penile fracture and eventual impact on postoperative erectile function.Ĭommon presentation of penile fracture demonstrates visual and sound appearances a snapping sound is heard, followed by extreme pain, accompanied with fast swelling of the penis and even some deformity, commonly known as eggplant deformity. In our series, trauma’ causes were similar to the Middle East reported mechanism, which is the flexing and bending of the erect penis in order to get the penis to a detumescent state. while sexual intercourse is the driving factor for western countries, penile manipulation is considered to be the prime cause in the middle east. 1, 4 The causes and circumstances differ depending on both cultural contrast and different etiologies. 4 It may also be explained by a marked short-term intracavernous pressure increase which exceeds the tunical tensile strength, and then the erect penis is more prone to injury. Penile fracture occurs exclusively during erection caused by a marked thinning of tunica albuginea. The descriptive data was resumed in Table 1. None of the cases has developed complaints as regards the frequency or rigidity of erections. 21 patients (15.3%) complained of penile curvature that was interfering with sexual intercourse and 18 patients (13%) stated that they had a painful intercourse. After 12 months of follow-up, the mean IEEF-5 score was 22. There was no significant postoperative morbidity except for two patients who had mild wound infection. Urethral repair was required in 13 cases (13.4%). The mean tear length was 16.5 mm (range = 7–37 mm). All tears were unilateral and on the ventral aspect of the penis. On surgical exploration, a tunical tear was found in the proximal shaft of the penis in 118 patients (85.5%) and in distal part in 20 patients (14.5%). Two different incisions were used: elective incision was performed in 112 patients (81.2%) while circumferential degloving incision was used in other cases whenever it was impossible to locate the tunical tear by physical examination. Spinal anesthesia was used for all patients. Decision of surgery was only based on clinical findings (history and physical examination). The mean surgery delay was 14.3 hours (range = 3-18 hours). Penile swelling and/or ecchymosis was present in all patients mostly involving the whole penis associated in four cases with scrotal swelling. Snap sound was heard by all patients except nine. By history, all patients had no problems with erectile function before penile fracture, only three patients had risk factors for systemic vascular diseases at first presentation, such as diabetes mellitus (two patients) and hypertension (one patient). The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 44.9% of cases followed by maneuvers during sexual intercourse in 34%. The presentation delay varied from 1 hour to 5 days (mean = 16.8 hours). The aim of our study was to identify the factors that may influence the sexual function after surgical repair.Ī total of 138 patients were operated for penile fracture in our department with a mean age of 31.2 years (range 19-55). 6 It has been reported that the incidence of ED after surgical repair of fracture penis ranges from 0% up to 12%. 7, 8 ED seems to be the most critical problem because of the serious physical and psychological consequences that may have on the patient. 1, 8 Serious complications such as penile curvature, erectile dysfunction (ED), development of plaques or urethral fistulas may develop due to inappropriate and/or late surgical repair. 6, 7 According to many recent studies, immediate surgical repair should be performed in order to have more adequate functional and cosmetic results. 4, 5 A loud snapping sound is usually heard by the patient associated with sharp penile pain and rapid detumescence. 1, 2, 3 The incidence of penile fractures is underreported because many patients do not seek medical attention due to the embarrassment of being seen with this unusual injury. Penile fracture is a traumatic rupture of the tunica albuginea of the corpus cavernosum secondary to blunt trauma to the erect penis with subsequent subcutaneous hematoma with or without rupture of the corpus spongiosum and the urethra.
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