The Consequences of Delayed Presentation and Management of Penile Fracture

Abstract

Background of study Penile fractures have traditionally been considered to require immediate surgical intervention. However, recent studies have described acceptable outcomes with delayed repair. In this prospective study, we investigated the consequences of delayed presentation and treatment of penile fractures.

Aim of Study: To assess the outcome of delayed presentation of cases with penile fracture on the long-term outcome of surgical intervention.

Patient and method: A prospective observational study was conducted between January and December 2022 and included 21 patients with penile fractures from multiple centers in Iraq who underwent surgery immediately after admission. To evaluate the outcome of the time to presentation, the patients were divided into two groups: Group A included 13 patients with early presentation within 24 hours (1 to 9 hours, mean = 3.93 hours) and Group B included 8 patients with delayed presentation after 24 hours (33 hours to 5 days, mean = 60.75 hours). All patients underwent routine follow-up at 1, 3, and 6 months after surgery; during this visit, long-term complications were reassessed using questionnaires and local examinations.

Results: Group A included 13 patients (61.9%) and group B included 8 patients (38.1%). In group A, patients presented to the emergency department within 24 hours after penile trauma. In group B, patients presented to the emergency department or clinic within 24 hours after penile trauma. The incidence of long-term complications was 7.6% (1 of 13 patients) in group A and 62.5% (5 of 8 patients) in group B (OR 26.4, 95% CI 4.41–157.86, p = 0.0001). Erectile dysfunction and penile mass did not differ significantly between the two groups (p = 0.67 and 0.06, respectively). However, pain during insertion and erection were higher in group B (50% and 7.6% in group B and group A, respectively) (OR 25, 95% CI 2.69-231.59, p = 0.1). Penile curvature was observed only in the second group (37.5%). However, the curvature was mild and did not affect sexual function.

Conclusion: Immediate surgical repair has the best prognosis and should remain the recommended treatment modality of penile fracture.