First aid and treatment of penile fractures

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Penile fracture is an uncommon condition that occurs due to sudden flexion of the erect penis. The diagnosis of penile fracture largely depends on history and focused physical examination. Such a fracture is a dangerous condition, so it needs to be first aided and treated promptly.

1. What is a penile fracture?

Penile fracture is an uncommon condition that occurs due to sudden flexion of the erect penis. These forces lead to tearing of the tunica albuginea (the lining of the erectile organs). This leads to an immediate loss of erection. In severe cases, a tear in the urethra (the canal that carries urine) may also occur.
Penile fracture is considered a urological emergency and when penile fracture is suspected, urgent urological consultation is sought. Failure to correct the wound caused by tunica albuginea is associated with slow growth of penile curvature and erectile dysfunction.

2. Causes of penile fracture

Penile fracture due to direct trauma to the erect penis. Besides, if during sex, the penis accidentally comes out of the vagina and the woman puts her own weight on the penis can also break the penis.
Anal intercourse, masturbation forcefully and rolling over on an erect penis during sleep can also cause a penile fracture. In certain ethnic groups, the practice of "Taqaandan" (intended to bend the erect penis during masturbation) may be the cause.

3. Penis fracture symptoms

It is not unusual for a patient to delay (up to several days) seeing his or her doctor or emergency department.
Men often complain of the force of flexion of the erect penis accompanied by pain and an immediate loss of erection. Usually, men will also admit to hearing a crunch. If the immediate loss of erection has not occurred, it is unlikely that a penile fracture has occurred.
Associated with this event may be profuse bleeding under the skin leading to the development of a large penile shaft and bruising and swelling of the scrotum. This is commonly known as eggplant deformity of the penis. In severe cases, a tear in the urethra (the canal that carries urine) may also occur. Signs of this are the presence of blood in the urine (gross or microscopic) or the inability to urinate.
The diagnosis of penile fracture largely depends on history and focused physical examination. Occasionally, if some aspect of the history or physical examination does not suggest a penile fracture, an x-ray may be performed.
Historically, cavernous printing was used to locate lacerations of tunica albuginea. This investigation was superseded by MRI or penile ultrasound. These imaging modalities are reserved for cases where the history or physical findings are not entirely consistent with penile fracture, in an effort to get the patient to the operating room.

4. First aid and treatment of penile fractures

The doctor will give you general anesthesia and open the skin through one or more incisions in the penis. Then, find the edge of the tear and close it with sutures. Sometimes these tears are wide and span half the circumference of the penis (usually transverse tears), requiring about 10 stitches. The surgery takes about an hour, and most people go home soon after. Most are able to resume sex for about a month (after the wound has healed).
Partial or total tearing of the foreskin can lead to long-term scarring and the accumulation of scar tissue can lead to erectile dysfunction or penile deviation, such as chronic curvature of the penis (causing the erection is bent to the side - sometimes at a 45-degree angle).
Men in their 20s and 30s, who tend to engage in more intense sexual activities face the highest risk, and men in their 40s and 50s have a lower risk.

5. Treatment options in penile fracture

If penile fracture is suspected, immediate surgical exploration should be performed. Even in cases of delayed onset longer than 48-72 hours after injury, penile fracture repair has been shown to reduce the incidence of penile curvature and erectile dysfunction when compared with observations.
The surgical procedure is usually relatively simple and involves draining accumulated blood, locating and repairing the defect. If there is concurrent urethral trauma, then proceed with urethral catheterization or perform direct urethral repair. Patients are usually discharged home the same day after surgery.
Sex is not allowed for 4 weeks after injury and repair. This method of management provides excellent preservation of both the anatomy and function of the penis.
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