|Year : 2015 | Volume
| Issue : 4 | Page : 132-134
Recurrent Penile Fracture: A Case Report and Review of Literature
Douglas Graham Ridyard, Elizabeth A Phillips, Ricardo Munarriz
Department of Urology, Center for Sexual Medicine, Boston Medical Center, Boston, MA 02118, USA
|Date of Web Publication||28-Oct-2015|
Douglas Graham Ridyard
701 Massachusetts Ave., Apt. 9, Boston, MA 02118
Source of Support: None, Conflict of Interest: None
We report the case of a 49-year-old man presenting with a recurrent penile fracture 1-year after undergoing delayed repair for a previous penile fracture. To the authors' knowledge, this case represents the first documented instance of repeat fracture occurring after delayed repair. Risk factors for repeat penile fracture are not well documented due to the rarity of this condition. A review of literature regarding repeat penile fracture and the impact of delayed repair is discussed.
Keywords: Genitourinary trauma, penile fracture, penis, surgical intervention
|How to cite this article:|
Ridyard DG, Phillips EA, Munarriz R. Recurrent Penile Fracture: A Case Report and Review of Literature. J Integr Nephrol Androl 2015;2:132-4
| Introduction|| |
Penile fracture is a rare urologic emergency involving rupture of the tunica albuginea of the corpus cavernosum with a cited annual incidence of 0.29-1.36 per 100,000 people and 1331 cases reported in the literature from 1935 to 2001. , Penile fracture generally occurs when significant bending forces are applied to an erect penis during sexual intercourse or aggressive penile manipulation. Patients typically report hearing a popping sound followed by immediate detumescence and pain.  Fracture of the corpus cavernosum results in the formation of a hematoma over the site of injury leading patients to classically present with the characteristic "eggplant deformity," with the penis deviating away from the site of the injury.  Experiencing penile fracture once in a person's lifetime is unlikely, but experiencing the injury twice is exceedingly rare. To the authors' knowledge, this case represents the first documented instance of repeat fracture occurring after delayed repair.
| Case Report|| |
A 48-year-old man presented to the emergency department 3 h after sustaining a penile injury during vaginal intercourse. He reported buckling of the penis associated with pain and swelling. He did not immediately lose his erection but was unable to continue the intercourse due to pain. In the emergency department, the patient was intoxicated with alcohol and was under the influence of marijuana. The examination was notable for significant swelling and tenderness, and ultrasound confirmed the penile fracture. The patient agreed to surgical repair of the fracture 7 days after the initial injury. A 3 cm transverse rent of the ventral right corpus cavernosum was repaired using 2-0 Vicryl ® suture. His postoperative course was unremarkable, and he suffered no early or late complications of the injury or repair.
Exactly 1-year and 1-day later, the patient presented to the emergency department with a recurrent penile fracture. The patient reported hearing a pop during intercourse followed by immediate pain and detumescence and was aware that he again had fractured his penis. The exam revealed a palpable right tunical defect. The patient was immediately taken to surgery where a fracture of the ventral right corpus cavernosum was again repaired. This defect was approximately 4 cm distal to his initial injury and the previous repair site was evident upon exploration. The patient's postoperative course was again unremarkable. He retains erectile function. To date, 1-year following the second injury, he has not re-injured the organ.
| Discussion|| |
Only seven cases of recurrent penile fracture were identified upon literature review. ,,,,, The interval of time between fractures ranged from 90 days to 9 years. , Mechanism of injury was only reported in two of the seven cases and was secondary to sexual activity. , Risk factors for recurrent fracture are difficult to ascertain due to its extreme rarity, however, as penile fracture has been associated with certain sexual positions or particularly vigorous intercourse, as well as manual penile manipulation, individuals who continue to engage in these activities would be at risk for repeat penile fracture.  It is also possible that prior fracture may introduce scar tissue which is vulnerable to repeat fracture, or more likely, that the fibrotic and nonelastic scar tissue of the previous injury makes the corpus surrounding this area weaker in comparison, thus putting the adjacent tunical tissue at higher risk for injury. This theory is supported by the predominance of cases, including the current case, which document repeat fracture occurring in the ipsilateral corpus cavernosum. ,, Interestingly, only one case of contralateral fracture has been reported.  Also, it has been hypothesized that the patients suffering from penile fracture may have a predisposition to this type of injury due to underlying structural abnormalities of the tunica albuginea. De Rose et al. demonstrated histological evidence of an underlying chronic inflammatory process in the tunica albuginea of patients presenting with a penile fracture. 
Although it has not been definitively established in the literature, the injury seems to preferentially occur in the patients with excellent preinjury erectile function. Most patients are young, with an average age of 36 years.  The patient discussed herein was older than the reported average, but he did have an excellent erectile function before and after both injuries. He stated that injury occurred similarly in both instances, with rear entry sexual position and buckling of the penis against the partner's perineum. The patient denied any particular significance of the day (i.e., it was not his birthday or any other holiday) and the injuries occurred with different partners, making it less likely that the partner contributed principally to inflicting the damage. Notably, the patient was under the influence of alcohol at the time of both injuries. The authors hypothesize that being under the influence of drugs or alcohol may also predispose one to this type of injury.
This patient received surgical repair of his penile fractures after both episodes with his first repair being delayed by a week after fracture. Surgical repair is currently the preferred management for patients presenting with penile fracture though optimal timing of repair continues to be investigated. Studies have repeatedly shown surgical repair to provide good long-term outcomes for patients. Erectile function is preserved in 92-98.6% of patients undergoing surgical repair compared to 20-59% of patients receiving conservative treatment. ,,
El-Assmy et al. reported no significant difference between group of patients receiving immediate versus delayed surgical repair, with regard to erectile function. 
Similarly, Phillips et al. found no difference in complication rate between groups of immediate and delayed repair, even when the delay is in excess of 1-week.  Some have reported preferential delayed repair at 7-12 days citing decreased swelling, increased ease of identification of injury allowing for smaller incisions, and less extensive exploration. ,
| Conclusion|| |
Risk factors leading to repeat penile fracture are largely unknown. Some causes may include the practice of consistently vigorous sexual acts or self-manipulation, the influence of drugs or alcohol or variations in the patient tissues prior to or following an injury. Larger series may further elucidate the risk factors for recurrent penile fracture. To the authors' knowledge, this case represents the first documented instance of repeat fracture occurring after delayed repair.
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Conflicts of interest
There are no conflicts of interest.
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