Penile Fracture and Trauma Guidelines

Updated: Jan 16, 2019
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines

Guidelines Summary

The American Urology Association (AUA) guidelines for diagnosis and management of genitourinary injuries were amended in 2017 to reflect literature that was released since the original publication in 2014. Key recommendations for the genital trauma include [25] :

  • Penile fracture should be suspected in a patient presents with penile ecchymosis, swelling, pain cracking or snapping sound during intercourse or manipulation and immediate detumescence 
  • Surgeons should perform prompt surgical exploration and repair in patients with acute signs and symptoms of penile fracture 
  • Ultrasound may be performed in patients with equivocal signs and symptoms of penile fracture
  • Evaluation for concomitant urethral injury should be performed in patients with penile fracture or penetrating trauma who present with blood at the urethral meatus, gross hematuria or inability to void
  • Surgical exploration and limited debridement of non-viable tissue should be performed in patients with extensive genital skin loss or injury from infection, shearing injuries, or burns (thermal, chemical, electrical)
  • Prompt penile replantation should be performed in patients with traumatic penile amputation, with the amputated appendage wrapped in saline-soaked gauze, in a plastic bag and placed on ice during transport
  • Initiate ancillary psychological, interpersonal, and/or reproductive counseling and therapy for patients with genital trauma when loss of sexual, urinary, and/or reproductive function is anticipated

The European Association of Urology guidelines for urological trauma were first published in 2003 and have undergone annual assessment of newly published literature in the field to guide updates. For the 2018 guidelines, all sections, with the exception of those related to imaging modalities, have been updated.  Key recommendations include the following  [8] :

  • A thorough history and examination usually confirm the diagnosis of penile fracture
  • Cavernosography, US or MRI can identify lacerations of the tunica albuginea in unclear cases
  • If a concomitant urethral injury is suspected, a retrograde urethrogram may be performed, however, flexible cystoscopy under anaesthesia during exploration/repair is more commonly employed
  • Surgical closure of the tunica should be carried out using absorbable sutures.
  • Conservative management of penile fracture is not recommended, as it significantly increases the rate of post-operative complications includeing penile abscess, missed urethral disruption, penile curvature, and persistent haematoma requiring delayed surgical intervention
  • Non-operative management is recommended for small superficial penetrating injuries with intact Buck’s fascia.
  • In more significant penetrating penile injuries, surgical exploration and debridement of necrotic tissue should be performed
  • Surgical re-implantation should be considered and performed within 24 hours of amputation
  • If the severed penis cannot be found, or is unsuitable for re-attachment, then the end should be closed as it is done in partial penectomy