Penile fracture repair: assessment of early results and complications using color Doppler ultrasound

The aim of this study was to determine early results and complications of penile fracture treated with immediate surgical repair by means of color Doppler ultrasound study. Four patients with the clinical features of penile fracture were submitted to immediate surgical exploration via a subcoronal incision with repair of the torn cavernosal albuginea (unilateral in three cases, bilateral in one case) and anastomosis of the transected urethra tone case), Color Doppler ultrasound (CDUS) was performed by means of an Acuson 128XP/10 using a 7 - 10 MHz extended frequency linear array transducer. Erectile function at five months follow-up was reported as normal by two patients (age 59 and 55 y), slightly decreased in one case (bilateral partial cavernous fracture + total urethral transection in a 32 y old) and weak in one case (51 y old). In the latter two, the investigation included a dynamic phase following a 10 meg PGE injection, B-mode ultrasound showed no fibrotic changes in relation to the long-term absorbable suture material. Baseline CDUS demonstrated full length integrity of the cavernous arteries in all patients, The CDUS dynamic study was entirely normal in the patient with weak erection while showed a continuos venous leak in the patient with bilateral cavernosal rupture and transected urethra. We conclude that despite the onset of erectile failure in two out of four patients, there was no evidence of arteriogenic impotence in any patients with major penile fracture and thus we advocate early simple repair without any microsurgical exploration of the cavernosal arteries.