In most cases, a penile fracture is caused by a mild or significant tear to the tunica albuginea within the penis. The “tunica albuginea” is the structure within the penis that fills with blood during an erection, and this penis anatomy section provides an illustration of the structure. Under the skin of your fingers, you can feel something firm and that is bone. Under the skin of the penis, there is a structure not as hard as bone, but it is somewhat firm during an erection, when the penis fills with blood, it is very firm. This is the tunica albuginea. If a man with a flaccid non-erect penis, were to bend his penis 90 degrees, this would not be expected to cause any pain or damage. However, if he were to do that forcefully with a fully erect penis, that would be expected to cause pain and damage. When the penis is erect, the tunica albuginea can be torn when there is bending or bucking. The tear usually occurs because of buckling trauma to an erect penis during intercourse with a missed thrust. When the fracture of the penis is severe and acute, the patient will often hear a “popping sound” and an immediate loss of the erection. The loss of the erection is due to blood exiting the tunica albuginea and accumulating under the skin, which can also lead to swelling of the penis.
Acute penile fracture. This patient underwent emergency penile fracture repair surgery and had an excellent outcome.
At the Center for Reconstructive Urology, we are often contacted shortly after the patient injures his penis. In other cases, we are contacted by men years after their injury seeking penile fracture repair. The treatment when there is a history of a penile fracture can depend on certain factors, and these will be reviewed.
Some men experience very mild buckling trauma without any serious side effects. Since there is no penile swelling following the trauma, they may or may not seek emergency penile fracture treatment. When a patient has any buckling trauma, the only issue for the Urologist to consider is: Do I have a reason to believe there is a tear of the tunica albuginea where a surgery would reveal a tear that can be repaired or not? If there is no suspicion of a tear (no swelling no bruising), testing and treatment are generally not necessary, as mild buckling trauma usually has no significant negative impact on the structure of the penis.
We are often contacted by men who report what may have been a penile fracture in the past, and that they never sought medical care for penile fracture surgical repair, or they went to a doctor who mistakenly did not recommend treatment of the penis fracture.
When a man gets a cut to his face, if it is a major laceration, he will generally go to the emergency room and get stitches to bring the skin back together. When that happens, the laceration heals with a scar, but that scar is generally very small ,and in some cases, not all that noticeable. However, if he does not get stitches, it will still heal, but it will head with a much wider harder scar. It is the same with the penis. The reason men with penile fracture benefit from penile fracture repair is so that the tear will heal with a better scar under the skin and that will help prevent the development of penile curvature and/or erectile dysfunction.
The many of our patients with penile curvature and/or erectile dysfunction and a history of a buckling injury during intercourse that was never treated, seek surgery to fix the penile fracture. The problem is that at that point, the fracture is completely healed. However, that healing was where the open defect filled in with scar tissue, and this then led to later problems. Once a penile fracture has healed, it is too late to do surgery to repair the penile fracture. However, we can treat both erecile dysfunction and penile curvature.
A fracture to the penis can be a traumatic event, and an acute penile fracture is considered a Urological emergency. In some cases, there can be an associated injuries to the urethra. It is not uncommon for men who sustain a penile fracture to go to their local Emergency Room. When that happens, the Emergency Room physician will call the “Urologist On-Call”. This is almost always a General Urologist who is not exclusively specialized in penile-urethral surgery. The recommended treatment is usually surgery which is done on an emergency basis. The Urologist will take the patient to the operating room, and under general anesthesia, will make an incision in the skin, often what is called a circumcising incision. This is a circular incision in the penile skin, allowing the skin to be pulled back (called de-gloving) to expose the torn tunica albuginia. The torn is then put back together with absorbable suture, and then the skin is sutured back together.
In most cases, the surgery is successful. However, we have seen over the years a number of patients with significant complications of penile fracture treatment. Examples include unrecognized urethral injuries that were not repaired leading to urethral strictures or injuries that were not repaired with an excellent result. We have been contacted by a number of patients who report that they sustained what they believed was a penile fracture that day, the previous day, or even several days prior to contacting us. They want to have surgery at our Center, and travel to see us for care. We have had patients travel from other parts of California and as far away as Santorini, Greece. Although the treatment of a penis injury such as a fracture is ideally performed without delay, we have found that these injuries are highly amenable to successful repair days after the injury, and believe it is better for men who had penile fractures to have surgery by someone with expertise than a doctor without experience who happens to be on-call for all Urologic emergencies.