Penile Fracture with Concomitant Urethral Injury: Surgical Decision Making Intraoperative Urethral Assessment and Functional Outcomes

Abstract

Background: Penile fracture is rupture of the tunica albuginea of the erect corpus cavernosum. It is a urological emergency requiring urgent surgical exploration. Concomitant urethral injury complicates 10–22% of cases and urethral injury patterns demonstrate anatomical heterogeneity, ranging from common proximal (bulbar) to rare distal (fossa navicularis–proximal) tears.

Aim: To assess the functional outcomes after repair of penile fracture with concomitant urethral injury

Materials and Methods: We conducted a retrospective analysis of five patients who were diagnosed with penile fracture and concomitant urethral injury between January 2016 to June 2026. They underwent systematic evaluation including clinical assessment, penile ultrasonography, and intraoperative cystoscopy. All patients underwent urgent surgical exploration within 24–48 hours of presentation. Data on injury pattern, surgical approach, repair technique, perioperative parameters, and follow-up outcomes were recorded.

Results: Five males aged 27–52 years (mean 38.2 years) were included. Concomitant urethral injury was confirmed in all patients. Intraoperative cystoscopy was performed in all patients. On follow-up, four patients had IIEF-5 score ≥22 (one of whom had a scar under surveillance), and one had mild ED. No urethral stricture, penile curvature, or urethrocutaneous fistula was identified in any patient.

Conclusion: This case series demonstrates the clinical and anatomical heterogeneity of penile fracture with variable urethral co-injury patterns. Systematic intraoperative cystoscopy enables accurate urethral localisation and guides simultaneous primary repair. Excellent functional outcomes are achievable, particularly with early presentation and repair.