Original Article
PENILE FRACTURE; ETIOLOGY AND MANAGEMENT
Muhammad Akram Malik1, M. Tahir Bashir2, Naveed Ashraf Malik3,
Muhammod Hussain2, Mohammad Sohail4
1
Associate Professor, Urology, University Medical Dental College, Faisalabad.
2
Senior Registrar, Utology, Allied Hospital, Faisalabad.
3
Assistant Professor, K.E. Medical College, Lahore.
4
Registrar, Madina Teaching Hospital/UMDC, Faisalabad.

ABSTRACT
Introduction:
Penile fracture is a rare urological emergency that occurs almost exclusively due to blunt
trauma on erect penis. Trauma causes tear in tunica albugenia. The diagnosis is straight
forward and based on classical history of snap sound, pain, detumescence, swelling and
deformity. Early surgical intervention gives good cosmetic and functional outcome.
Material and Methods:
This retrospective study was conducted between Jan 2001 to Dec 2010. Patients presented with
penile fracture were included in the study. All patients were managed by sub-coronal incision
and repair of tunica albugenia tear with prolin (Polypropylene) 3/0.
Results:
Thirteen patient of penile fracture with age range of 17-48 years (mean=34 years) presented
to us. Ninety two percent of patients were below 40 years. Eighty four percent suffered injury
during coitus. Almost all patients experienced cracking sound followed by pain, swelling,
detumescence and deformity. Interval between trauma and presentation varied from 06 hours
to 14 days (mean=60 hours). Twelve patients were managed surgically and 01 managed
conservatively. Painful coitus was the only complication reported. Majority of patients (53.84%)
experience successful intercourse with in 04 weeks. None of the patients reported impotence.
Conclusion:
Penile fracture is a rare urological emergency which requires early surgical intervention for
better outcome and minimal rate of complications.
Keywords: Penile fracture, Corpus cavernosum, Tunica albugenia, Penile trauma.

INTRODUCTION allngenia gives a snap sound. Classically there

Penile fracture is a rare urological emergency
that occurs almost exclusively due to blunt
Corresponding Author:
Dr. Muhammad Akram Malik,
Associate Professor,
Madina Teaching Hospital,
University Medical & Dental College, Faisalabad.
Email: akrammlk@yahoo.com
trauma during erection. Penile fracture is a
misnomer. Infact it is the rupture or tear in
tunica-albugenia. This rupture in tunica
is history of snap sound, pain, detumescence
and haematoma of penis with deformity.
Penile fracture has been reported with sexual
intercourse, masturbation, rolling over the
bed or falling on to erect penis1. The most
common cause is violent sexual activity
especially in a position of female partner
playing the active role (Upper position)2.
Penile fracture has also been reported in
children. Patients may delay the admission
due to fear or embarrassment or condition
may be under reported.

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 MALIK MA, et al. PENICLE FRACTURE

The diagnosis is usually straight forward
because of stereotypical clinical presentation.
Associated injuries includes urethral rupture.
Rupture of tunica is unilateral in most cases
although bilateral rupture associated with
urethral rupture also occurs.
Immediate surgical repair is advocated though
suture material is controversial3,4. Most
authors recommended degloving incision,
evacuation of haematoma and repair of rent
of tunica albngenia, with absorbable or non
absorbable suture.
Diagnostic investigation includes ultrasonography
and retrograde urethrogram5. Presence of
haematoma and breach in tunica albugenia is
detected by ultrasonography. Urethrogram is
helpful in establishing rupture of urethra
although some authors advocate flexible
urethrocystoscopy to detect any breach in
case of suspicion. Delay in surgical repair
should not be done due to investigation for
diagnosis, which is straight forward in most of
cases.
Unsatisfactory penile curvature and erections,
penile abscess and urethral strictures have
been reported in relation to penile fracture.6
PATIENTS AND METHODS
This retrospective study was conducted at
Department of Urology Madina Teaching
Hospital, Faisalabad, Department of Urology,
Allied Hospital, Faisal Hospital and Mian
Muhammad Trust Hospital, Faisalabad. Record
of all the patients of penile fractures admitted
from January 2001 to December 2010 were
reviewed. Thirteen patients presented with
penile fracture were included in the study.
Their records were reviewed, data was
tabulated and analysed. Exploration was
performed by circumferential degloving
incision. Haematoma evacuated and repair of
rent was performed with prolin3/0. Associated
urethral injuries, which were minor managed
conservatively by putting a foly catheter and
keeping it for two weeks. Major urethral injury
was repaired with vicryl (Polyglactin) 3/0
primarily. Thirteen patients presented with
penile fracture were included in the study.
Their records were reviewed and data was
tabulated and analyzed.
RESULTS
There were thirteen patients of penile fracture
presented in 10 years period (January 2001 to
December 2010). Age ranges from 17 to 48
years with a mean of 34 years.
Most of the patients (92.30%) were below the
age of 40 years. Majority (84.61%) suffered
the injury during coitus, however,
masturbation and falling on bed were other
causes of trauma. Twelve patients were
married (Table 1). All the patients
experienced cracking sounds followed by pain,
haematoma, swelling and penile deformity.
Two of these presented with heamaturia,
associated with pain and swelling. The interval
between trauma and presentation varied from
06 hours to 14 days, with a mean 60 hours.

Table 1. Patient characteristics and clinical presentation

Sr.# Particular Range Mean

1. Age 17-48 years 34 yrs.
2. Marital Status:
Married 12
Unmarried 01
3. Duration before presentation 06 hours02 weeks 60 hrs.
4. Clinical presentation:
Cracking sound, pain, swelling, and detamenscence deformity 11 patients
Pain, swelling deformity and bleeding per urethra 01 patient
Bleeding per urethra 01
5. Etiology:
Coitus 11
Masturbation 01
Rolling into bed 01

12 JUMDC Vol. 2, Issue 2, Jul-Dec 2011

 MALIK MA, et al.
Twelve patients were treated surgically and
only one was managed conservatively. Tear of
tunica was unilateral in 11 patients while
bilateral tears were present in 01 patient. Two
patients were having urethral involvements
(Table 2). Duration of hospital stay varied
from 02 to 07 days. Follow up ranged from 2-
6 months. Painful coitus was main
complication in majority of patients. Majority
(53.84%) patients resumed their sexual
activity within 04 weeks duration, except one
which was successful in performing intercourse
after 06 months. He was having normal night
time erections but due to fear of trauma could
not perform intercourse, for long time. None
of patients reported impotence in this series.
Table 2. Operative findings and management/
follow up
Tunica Tear:
Single 11
Double 01
Associated urethral involvement 01
Isolated urethral tear 01
Management:
Repair 12
Conservative 01
Follow up Errections:
With in one month 07
With in 01-02 month 02
With in 02-05 month 03
At 06 month 01
 due to small number of patients in our series.
DISCUSSION
Penile fracture is rare however, it is being
reported with increased frequency in the
recent past7.
Coitus is the main etiological factor in our
series, however non coital factors like
masturbation, direct trauma etc are being
reported in literature5,6.
Presentation of patients is little late in our
series as compared to other series. This may
be due to shame and fear of some questions.
This late presentation is similar to other series
reported from Muslim countries.8,9 El Sharif et
al. and Paul D Ek et al. reported a high
incidence of non-coital injuries in their series
among Saudi, Qatari and Nigerian patients10.
They also have reported late presentation by
the patients.
JUMDC Vol. 2, Issue 2, Jul-Dec 2011
PENICLE FRACTURE
Unilateral rupture/tear of tunica was present
in 11 patients. Two patients had urethral
injury which is slightly less than others
studies8,9,10.
El-Sherif et al. also had low incidence of
associated urethral injury and attributed it to
high incidence of non-coital injury, however
other studies have not linked this causative
factor. There is no explanation of urethral
involvement in few patients with coital or non-
coital trauma of penis. Our department used
standard approach of sub-coronal incision,
degloving of penis and repair of tunica tear.
Few Urologists have recommended direct
incision over haematoma and repairing of
tear. They claim this technique as less
traumatic and have low rate of complications
such as skin necrosis and infections.11 Our
results are comparable with other series as far
as rate of complications are concerned.
Advantages of coronal incision and degloving
are relatively good cosmetic results, good
exposure and repair with single incision in
case of bilateral tunica rupture and associated
urethral injury12.
Non-operative/conservative treatment of penile
fracture has reported to have 10-20%
incidence of penile deformities13. Other long
term complications like arteriovenous fistula
have been reported14, however we did not
encounter such complications, this may be
One patient managed conservatively with no
complication and satisfactory erections and
intercourse. This approach has also been
reported in literature15.
CONCLUSION
Penile fracture is a rare urological emergency,
which requires earlier surgical intervention for
better outcome and minimal complications.
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Submitted for publication: Aug, 2011
Accepted for publication: Nov, 2011
JUMDC Vol. 2, Issue 2, Jul-Dec 2011