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Also known as
Fractured penis, broken penis, penis fracture, corpus cavernosum rupture, traumatic rupture of the tunica albuginea, cavernosal rupture
Definition
Penile fracture is defined as the traumatic rupture of the tunica albuginea of an erect penis.¹ This condition occurs when the engorged penile corpora cavernosa are forcefully bent or hit, causing the pressurized erectile tissues to “pop” under the strain of blunt trauma.² The tunica albuginea, a strong fibrous connective tissue layer that covers the corpora cavernosa, normally has a thickness of approximately 2 mm when the penis is flaccid. However, during erection, this tissue thins to just 0.25 mm as the corpora become engorged with blood, making it more susceptible to rupture under abnormal pressure or bending.³
During a penile fracture, the intracavernosal pressure can exceed 1500 mmHg, surpassing the tensile strength of the thinned tunica albuginea and resulting in its rupture.⁴ This typically occurs on the ventral side of the penile shaft adjacent to the urethra, which represents the weakest point of the tunica.⁵ The rupture leads to immediate detumescence (loss of erection), significant pain, and rapid development of swelling and bruising due to blood extravasation from the corpora cavernosa. In approximately 20% of cases in Western countries, the urethra may also be damaged, potentially causing urinary symptoms and complications.⁶
Clinical Context
Penile fracture is considered a urological emergency that requires prompt diagnosis and surgical intervention to prevent long-term complications.¹ The condition most commonly occurs during sexual intercourse, particularly when the erect penis slips out of the vagina and is forcefully thrust against the partner’s perineum or pubic bone.² In Western countries, approximately 33-58% of cases occur during sexual activity, while in Middle Eastern and Asian countries, the etiology often differs, with many cases resulting from manual bending of the erect penis (a practice called “taqaandan” in some cultures) to achieve detumescence.³
Patient selection for surgical intervention is based primarily on clinical presentation. The classic triad of symptoms includes: (1) a popping or cracking sound at the moment of injury, (2) immediate detumescence, and (3) rapid development of pain, swelling, and penile deformity.⁴ Physical examination typically reveals the “eggplant deformity,” characterized by penile swelling, discoloration, and deviation toward the side opposite to the fracture.⁵ The presence of blood at the urethral meatus, hematuria, or difficulty urinating suggests concomitant urethral injury, which occurs in approximately 20-38% of cases in Western countries.⁶
Diagnostic evaluation may include retrograde urethrography if urethral injury is suspected, particularly in cases with bilateral corporal rupture, which has a higher association with urethral trauma.⁷ Ultrasound or MRI may be used in equivocal cases but are generally not necessary when the clinical presentation is typical.⁸
The standard treatment is prompt surgical exploration and repair of the tunica albuginea defect, ideally performed within 24-48 hours of injury.⁹ Surgical approaches include a circumferential subcoronal incision with penile degloving, which provides excellent exposure of the entire penile shaft, or a direct longitudinal incision over the hematoma site.¹⁰ The torn edges of the tunica albuginea are repaired with absorbable sutures, and any associated urethral injury is repaired primarily.¹¹
Conservative management (observation, pressure dressings, anti-inflammatory medications, and antibiotics) has historically been associated with higher complication rates, including erectile dysfunction, penile curvature, and painful erections.¹² Studies have demonstrated that early surgical intervention results in shorter hospital stays, less penile deformity, and better preservation of erectile function compared to conservative management.¹³
Postoperative care includes antibiotics, urinary catheterization if urethral repair was performed, and abstinence from sexual activity for 4-6 weeks.¹⁴ Long-term follow-up is recommended to monitor for complications such as erectile dysfunction, penile curvature, or urethral stricture.¹⁵