Clinical appraisal of corpora cavernosa injuries (penile fracture): Retrospective review of 69 patients in Benghazi, Libya

Abstract

Background and Aim: Penile fracture is a relatively rare urological emergency. The aim of this study was to review the experience with 69 consecutive cases in Benghazi, Libya. Patients and Methods: Records of 69 penile fracture cases who presented between January 1997 and December 2018 to Hawari Center for Urology, Benghazi, Libya were retrospectively reviewed. Penile fracture diagnosis was based on classic history and typical physical signs. Surgical exploration was performed for all patients under spinal anesthesia. Results: The most common mechanism of penile fracture was self-inflicted forceful bending (manipulation) of erected penis which account for 39 (56.5%) patients, followed by vigorous sexual intercourse in 19 (27.5%) patients, masturbation in five (7.2%) patients, rolling over an erect penis in bed in five (7.2%) patients, and slipping in WC in one (1.5%) patient. Clinical features at presentation include intense pain in 97%, sudden audible popping sound in 87%, rapid de tumescence in 94.2%, followed by development of swelling and ecchymosis in all patients (100%). All patients were treated surgically and no intraoperative or immediate postoperative complications were encountered. During the follow-up period, all patients had normal urinary steam and normal sexual function was experienced by 97.1% of the patients. Five patients (7.2%) had long-term complications: penile hypoesthesia (one patient), painful erection (one patient), penile curvature of <15o on erection (one patient), and mild erectile dysfunction (two patients). Most patients were discharged home on postoperative day 1. Conclusion: Penile fracture occurred mainly due to forceful sexual manipulation of erected penis, and diagnosis can be made clinically. Immediate surgical repair is the only option to avoid complications.