Penile Fracture

Penile fracture is rupture of the tunica albuginea of one or both corpora cavernosa during erection.

The tunica becomes very thin during erection and can rupture when the erect penis bends forcefully.

Typical mechanisms include:

Sexual intercourse
Forceful penile manipulation
Masturbation
Rolling onto the erect penis

Urethral injury accompanies approximately 10% to 20% of fractures.

Penile fracture requires surgical repair.

Ideally operate within 24 hours, although delayed presentation should still be explored and repaired rather than treated conservatively.

Surgical repair

Expose the tear using:

Local targeted longitudinal incision

Subcoronal circumferential degloving incision

Evacuate haematoma.

Identify the tunical defect.

Close tunica albuginea using absorbable sutures.

Inspect the opposite corpus when bilateral injury is possible.

Urethral injury

Repair associated urethral injury during the same operation.

Small partial tears can undergo primary closure over a catheter.

Complete injury without tissue loss undergoes tension free anastomotic repair.

Postoperative care

Use urethral catheter according to urethral involvement.

Advise avoidance of intercourse and vigorous sexual activity until adequate healing, commonly approximately 4 to 6 weeks.

Surgical treatment markedly lowers the incidence of:

Erectile dysfunction
Penile curvature
Painful erections
Persistent haematoma

compared with conservative treatment.

Benign Prostatic Hyperplasia

Also known as: BPH

Non-malignant hyperplasia of prostatic transition zone tissue causing bladder outlet obstruction, increasing in prevalence with age from the 40s onward.

Lower urinary tract symptoms (LUTS): storage (frequency, urgency, nocturia) and voiding (hesitancy, weak/intermittent stream, straining, incomplete emptying, terminal dribble). DRE: smooth, symmetrically enlarged, firm-elastic prostate (irregular/hard/asymmetric nodularity raises malignancy concern). Complications: acute urinary retention, recurrent UTI, bladder stones, chronic retention with overflow incontinence, hydronephrosis/renal impairment.

IPSS score: mild (0-7), moderate (8-19), severe (20-35) — guides management
DRE: size, consistency, nodules
PSA: discuss risks/benefits first; elevated in BPH, prostatitis, and cancer — not diagnostic alone
Urinalysis: exclude infection/hematuria
U&E/creatinine: if chronic retention/hydronephrosis suspected
Post-void residual (bladder scan): assesses incomplete emptying
Uroflowmetry: objective flow assessment (specialist)

Differentials: prostate cancer, urethral stricture, bladder neck dysfunction, overactive bladder, UTI, neurogenic bladder, prostatitis.

Mild (IPSS <8): watchful waiting, reduce evening fluids/caffeine/alcohol, bladder training
Alpha-blockers (first-line, rapid relief): tamsulosin 400mcg od, alfuzosin 10mg od, doxazosin 1-8mg od (titrate) — side effects: postural hypotension, retrograde ejaculation, intraoperative floppy iris syndrome (inform ophthalmologist pre-cataract surgery)
5-alpha reductase inhibitors (larger prostates, reduces volume over months): finasteride 5mg od, dutasteride 0.5mg od — 3-6 months for effect, reduces PSA ~50% (adjust interpretation), side effects: ED, reduced libido, gynecomastia
Combination therapy: superior long-term outcome for larger prostates with moderate-severe symptoms
Tadalafil 5mg od: alternative/add-on, particularly with comorbid ED
Antimuscarinic/beta-3 agonist (mirabegron): add-on for persistent storage symptoms — ensure adequate voiding first
Acute retention: urgent catheterization, trial without catheter after alpha-blocker initiation; urology referral if fails
Surgery (severe/refractory, complications): TURP — gold standard; laser enucleation/vaporization, minimally invasive options (UroLift, Rezum) for selected patients

Referral: urology for refractory symptoms, complications, or suspected malignancy.

Penile Fracture

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management