A penile fracture is a urological emergency involving the traumatic rupture of tissue, not bone. This injury occurs when the erect penis is subjected to sudden, blunt force or sharp bending. It is defined as a tear in the tunica albuginea, the thick, fibrous sheath surrounding the erectile chambers (corpora cavernosa). During an erection, the tunica albuginea is thinner and less elastic, making it susceptible to tearing under high pressure. Immediate surgical repair is the accepted treatment to prevent serious long-term complications and restore normal function.
Recognizing the Injury and Necessity of Emergency Care
The injury is usually heralded by a distinct audible popping or cracking sound as the tunica albuginea ruptures. This sound is immediately followed by severe pain and the rapid loss of the erection, a process called sudden detumescence. Blood rapidly leaks from the torn erectile tissue, causing a large, dark bruise and swelling, often described as an “eggplant deformity.”
Diagnosis is typically made through a clinical examination based on the patient’s history and these classic physical signs. In cases where the clinical presentation is unclear, an ultrasound or magnetic resonance imaging (MRI) may be used to identify the tear.
Immediate transportation to an emergency department is mandatory for surgical intervention, which should ideally occur within 24 hours of the injury. Delayed treatment significantly increases the risk of permanent complications. Prompt repair is the most effective way to minimize long-term issues like severe penile curvature or erectile dysfunction. Concomitant injury to the urethra, which can occur in a small percentage of cases, also requires immediate attention to preserve urinary function.
The Procedure for Surgical Repair
The primary goal of the operation is to locate and close the tear in the tunica albuginea and to evacuate any pooled blood (hematoma). Surgeons typically use a circumferential incision near the head of the penis, which allows the skin to be pulled back, providing excellent exposure to the entire length of the erectile bodies. An alternative approach is a direct incision over the palpable site of the tear, which minimizes tissue dissection but may not allow for a complete inspection of the penis.
Once the tear is identified, the hematoma is carefully drained to reduce pressure and swelling. The surgeon then uses fine, absorbable sutures to meticulously close the rupture in the tunica albuginea. Absorbable sutures are used because non-absorbable materials are associated with a higher incidence of palpable scarring.
A secondary step involves checking for injury to the urethra. If the patient presented with blood at the opening of the penis or difficulty urinating, a specialized X-ray study or direct visualization may be performed during surgery. When a tear in the urethra is found, it is repaired with fine sutures over a temporary urinary catheter.
Immediate Post-Operative Recovery
The hospital stay following surgery for a penile fracture is generally brief, often lasting only one to three days. Pain management is a focus, with prescribed oral medications used to maintain comfort after anesthesia. Swelling and bruising are expected, but they gradually subside over the first one to two weeks.
A urinary catheter is typically placed during the procedure and may remain for 24 to 48 hours to allow the urethra to rest and heal. If the surgery involved a repair of the urethra, the catheter will need to stay in place for a longer period, often up to two weeks. Patients are given instructions on wound care, which involves keeping the surgical dressing clean and dry for the first few days before gently removing it.
Activity is restricted in the short term to prevent strain on the surgical repair. Patients should avoid strenuous activity and heavy lifting for several weeks. A primary concern in the immediate recovery phase is preventing spontaneous, painful nocturnal erections that could disrupt the suture line. Some surgeons may prescribe medication for a short time to suppress these erections, although the pain itself often serves as a natural deterrent.
Long-Term Functional Outcomes
The prognosis for functional recovery after prompt surgical repair is excellent, with high rates of success. The vast majority of patients (over 90%) regain full erectile function adequate for intercourse. The ability to resume sexual activity typically occurs between six to twelve weeks after the surgery, pending the surgeon’s clearance and the resolution of pain and swelling.
While surgical outcomes are positive, patients should be aware of potential long-term complications. The most common residual issues include a palpable nodule or scar at the site of the repair and the development of new-onset penile curvature, also known as Peyronie’s disease. Penile deviation occurs in a small minority of cases and may sometimes require further intervention if it is severe enough to impede intercourse.
A small percentage of individuals may also experience persistent erectile dysfunction, often less than 10% of surgically treated cases. This risk is significantly higher in patients who attempt non-surgical management or who delay surgical treatment. Immediate surgical repair offers the best prospect for minimizing long-term complications and ensuring the preservation of both sexual and urinary function.