Penile fracture in Kermanshah, Iran: the long-term results of surgical treatment.

OBJECTIVE: To determine the long-term outcome of the surgical management of penile fracture. PATIENT AND METHODS: In all, 170 patients (mean age 27 years, sd 13, median 24, range 13-80) with penile fracture undergoing surgery between April 1990 and December 2000 were reviewed. In addition to a history, physical examination and hospital records, long-term potency (> 6 months after surgery) was evaluated using the patients' self-rated assessment of erectile function and the International Index of Erectile Function (IIEF-5) questionnaire. The results were correlated with the surgical findings. A control group of 200 men also self-rated their erectile function and completed the IIEF-5. For those patients who presented with their partners, the partner's satisfaction with erections was also evaluated. The mean (median, range) follow-up after injury was 53 (61, 6-132) months.
RESULTS: Satisfactory and painless erectile function with a soft straight penis was reported by 162 patients (95.2%). Complications occurred in eight patients (4.7%), of whom seven developed a mild (four) to moderate (three) penile curvature; five had penile nodules and four reported mild paresthesia over the scar line. Mild and moderate erectile dysfunction (ED) was reported by five and three patients, and four and five of controls, respectively (P > 0.05). There was no difference between the surgical findings of six patients with complications and those of the remaining 162. However, in the two remaining cases extensive injury was associated with moderate ED after surgery. Of eight patients with ED, seven responded to intracavernosal injection with papaverine/phentolamine. Erectile function returned within a mean (range) of 2 (1-5) days and coitus was possible approximately 2 weeks after the repair. Of the patients' partners, 94.1% reported satisfaction with erections and only one reported de novo dyspareunia. Penile fracture was not associated with an increased risk of ED (odds ratio 0.95; 95% confidence interval, 0.35-2.53). In sexually active participants, the mean (sd, range) IIEF-5 score for 162 patients was 23.2 (2.7, 13-25) and not significantly different from that for the 194 controls, at 22.8 (2.1, 11-25). However, patients had higher scores than controls for erectile firmness and maintenance ability (P < 0.05).
CONCLUSIONS: Surgery for a fractured penis is safe and effective, restoring erectile function to that of controls. Surgical treatment is very satisfactory for patients and partners. Considering these encouraging results, surgical intervention is strongly recommended.