Penile fracture occurs exclusively during erection caused by a marked thinning of tunica albuginea.4Kamdar C Mooppan UMM Kim H et al.Penile Fracture: preoperative evaluation and surgical technique for optimal patient outcome. 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.1Ateyah A Mostafa T Abdel Naser T et al.Penile fracture: surgical repair and late effects on erectile function.,4Kamdar C Mooppan UMM Kim H et al.Penile Fracture: preoperative evaluation and surgical technique for optimal patient outcome. The causes and circumstances differ depending on both cultural contrast and different etiologies. while sexual intercourse is the driving factor for western countries, penile manipulation is considered to be the prime cause in the middle east.,10Fergany AF Angermeier KW Montague DK. Review of cleveland clinic experience with penile fracture.

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. 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.

Common 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.1Ateyah A Mostafa T Abdel Naser T et al.Penile fracture: surgical repair and late effects on erectile function. 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.11Penile fracture and soft tissue injury.,12Choi MH Kim B Ryu JA et al.MR imaging of acute penile fracture. Reports also point to the right side of the penis as the most affected by the leisure, as a matter of fact, Ateyah et al1Ateyah A Mostafa T Abdel Naser T et al.Penile fracture: surgical repair and late effects on erectile function. linked this to the fact that right-handed population is greater than left-handed ones among the patients, thus the penile manipulation is frequently to the left side, resulting obviously in tunical tears on the right side. It has been reported that the right side is the most commonly affected by the injury.3Sexual function and tunica albuginea wound healing following penile fracture: an 18-year follow-up study of 352 patients from Kermanshah, Iran.,11Penile fracture and soft tissue injury. During our study, we saw that the ventral area of the penis is the most impacted by these tunical tears, which is may be due to the dorsal thickness of the tunica albuginea.To deal with penile fracture, two divergent approaches are usually adopted, surgical and conservative.13Jack GS Garraway I Reznichek R et al.Current treatment options for penile fractures. The most recent studies showed that the surgical approach is the one to revert to in dealing with any case of penile fracture.14Al-Shaiji TF Amann J Brock GB. Fractured penis: diagnosis and management. Our results obviously reinforce and opt for the surgical approach as the primary standard in managing a penile fracture, as the aftermath shows great functional results. The vast majority of surgeons use subcoronal circumferential incisions.15Nicolaisen GS Melamud A Williams RD et al.Rupture of the corpus cavernosum: surgical management.,16Asgari MA Hosseini SY Safarinejad MR et al.Penile fractures: evaluation, therapeutic approaches and long-term results. Yet it seems useless to actually perform a full penis degloving by circumferential incision in order to detect unilateral tear as it poses risks of impacting tissues and vessels. Furthermore, Ekwere et al. demonstrated that such exaggerated dissection may possibly raise the tendency of skin necrosis, decreased penile sensation and hematoma.17Trends in the incidence, clinical presentation, and management of traumatic rupture of the corpus cavernosum. Nonetheless, our series displayed a much higher rate of penile curvature linked with elective incision. The time gap between the injury and the surgery was considered, according to two different series, to be the most leading factor of late complications.18Karadeniz T Topsakal M Ariman A et al.Penile fracture: differential diagnosis, management and outcome., 19Penile fracture with complete urethral disruption.-20Penile fracture in Kermanshah, Iran: the long-term results of surgical treatment. Indeed, it is agreeing with our found results which pointed to the report delay having a central role, among others, in the evolution of the erectile dysfunction. In the literature, ED ranged from 0% in small series to almost 12% in other reports, in our case, we had a higher range of ED subsequently of 12 months follow up.21Koifman L Cavalcanti AG Manes CH et al.Penile fracture—experience in 56 cases. The sexual dysfunction resulting from penile fracture is either due to penile curvature, ED (linked to an organic or psychogenic element), or simply painful intercourse. Numerous authors advocate performing color Doppler ultrasonography to investigate ED, which would allow display of arterial insufficiency, persistent venous leakage or veno-occlusive dysfunction. Also, it may help to show normal Doppler indices, specifically in case of psychogenic.2El-Assmy A El-Tholoth HS Abou-El-Ghar ME et al.Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture.,22Penson DF Seftel AD Krane RJ et al.The hemodynamic pathophysiology of impotence following blunt trauma to the erect penis. In such cases, patients may declare that they are experiencing fear of recurrence while performing sexual activities, which leads to the interruption of said activity.2El-Assmy A El-Tholoth HS Abou-El-Ghar ME et al.Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture. Comparing CDU assessments from both intact and injured sides reveals to be useful to detect ED of injured sections of the penis. El-Assmy et al. uncovered that main risk factors are aging > 50 years at presentation and bilateral corporal involvement.2El-Assmy A El-Tholoth HS Abou-El-Ghar ME et al.Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture. However, not even one of these signs is to be found related to ED according to our results. Penile nodules may or may not be associated to penile curvature. Only 4.1% of the patients, as reported by Zargooshi, were seen to develop penile curvature after 24 months, while Hinev stated an 8% percentage of patients complained about penile curvature within a year.20Penile fracture in Kermanshah, Iran: the long-term results of surgical treatment.,23Fracture of the penis: treatment and complications. We discovered in our series that presentation time delay, tunical leak location and elective incision are the three factors linked with higher penile curvature.

Hence, we concluded that the follow up should be extended to reach a more definitive conclusion on complications. Painful intercourses appear to be the most common complication in the first months following surgical treatment, yet they diminish with time. As a matter of fact, no element or factor was linked with this complication according to our results.