Lessons learned after 20 years' experience with penile fracture

Impact of the timing of surgery on the recovery of sexual functions after fracture penis

Background

Fracture penis is an uncommon urological emergency, which often results from sexual trauma. Diagnosis remains clinical, and early surgical management is advocated. However, the timing of the repair may have a bearing on the outcomes. Herein, we share our experience of 17 such cases and compare the complications and the sexual function in relation to the timing of the surgery.

Methods

The records of all patients with a penile fracture who had presented to our hospital between 1st Mar 2015 and 28th Feb 2021 were reviewed. All patients were managed surgically. The patients were divided into three groups based on the time elapsed between the injury and the surgery. All patients were followed up for 6 months and the development of complications was recorded. The sexual function was assessed with International Index of Erectile Function (IIEF) at the end of 6 months.

Results

A total of 17 patients were included in the study. Coital trauma was the most common cause, followed by masturbation. 15 out of the 17 patients were operated on within 48 h of the injury. There were no long-term complications except for one patient having a palpable painless nodule at the site of the repair. At 6 months follow-up all patients who had an immediate surgical repair on presentation, had a normal sexual function, and there was no difference between those who presented early or after 48 h of injury.

Conclusion

Immediate surgical intervention should be the treatment of choice for all patients with a penile fracture, even if they present late, to prevent complications and erectile dysfunction.

Comparison of erectile and ejaculatory functional outcomes between unilateral and bilateral cavernosal rupture in penile fractures

This study aimed to compare the erectile and ejaculatory functional outcomes of unilateral and bilateral ruptures of the corpus cavernosum in penile fractures. Sixty patients' data were analyzed retrospectively between June 2020 and January 2023. The patients were divided into two groups based on the affected corpus cavernosum (unilateral and bilateral). Preoperative and postoperative 3rd-, 6th-, and 12th-month self-estimated intravaginal-ejaculation-latency-time (IELT), and international index of erectile function-erectile function (IIEF-EF) scores as well as the presence of urethral injury were compared. Bilateral corpus cavernosum fractures were detected in 18.3% of the patients. The IIEF-EF scores of both groups at 3rd-, 6th-, and 12th-month were found to be significantly lower than the preoperative scores (unilateral group:24.1 ± 2.7 vs 23.2 ± 3.5 and 23.3 ± 3.4, respectively, p = 0.011 and 0.014, respectively; bilateral group: 24 ± 1.9 vs 23 ± 1.8 and 23.2 ± 1.5, respectively, p = 0.027 and 0.047, respectively). No significant difference was found between the preoperative and the postoperative 12th month IIEF-EF scores in either group (unilateral group: 24.1 ± 2.7 vs 23.4 ± 3.6, p = 0.207;bilateral group:24 ± 1.9 vs 23.2 ± 1.5, p = 0.057). The self-estimated IELTs of both groups at the postoperative 3rd, 6th, and 12th months demonstrated a significant increase from the preoperative values (unilateral group: 221.6 ± 81.8 vs 252 ± 94.6, 256.5 ± 97.6, and 250.5 ± 104.8, respectively, p < 0.001; bilateral group:241.8 ± 61.6 vs 278.1 ± 55.4, 281.8 ± 56.1, and 283.6 ± 54.2, respectively, p = 0.041, 0.030, and 0.047, respectively). The changes in self-estimated IELTs and IIEF-EF scores between the preoperative period and the postoperative 3rd, 6th, and 12th-months were compared, and no statistical difference was found between patients with unilateral and bilateral corpus cavernosum fractures (p > 0.05). In conclusion, no significant difference in erectile function was found in either group at the 12-month follow-up, and the self-estimated IELTs were found to be prolonged in both groups. Furthermore, no difference was noted between the groups at any follow-up. To explain the effects of unilateral and bilateral injuries on erectile and ejaculatory functions, further studies with a larger-number of patients are necessary.

Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma

CONTEXT

The European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care.

OBJECTIVE

To present a summary of the 2023 version of the EAU guidelines on the management of urological trauma.

EVIDENCE ACQUISITION

A systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series.

EVIDENCE SYNTHESIS

Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance.

CONCLUSIONS

The guidelines provide an evidence-based approach for the management of urological trauma.

PATIENT SUMMARY

Trauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.

What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis

PURPOSE

Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential.

MATERIALS AND METHODS

A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated.

RESULTS

12 relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005.

CONCLUSION

The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

Penile Trauma Burden and Aetiology in the Paediatric and Adult Population: A Scoping Review and Critical Analysis of the Literature

Penile trauma is rare. It is associated with the impairment of physiological functions and deterioration in patients' quality of life. Currently, the relevance of age demographics in the occurrence of this debilitating injury has not been well discussed. The objective of this study was to provide a scoping review of penile trauma within the lens of the legal age of maturity. A search of the PubMed, Scopus and Web of Science databases was conducted, and then, the identified publications were used to conduct this scoping review focussing on the study aim. The results identified were categorised into five themes. This included publication information (author, year, country, study duration); demographic information (age of presentation, number of patients, relative burden); penile trauma clinical pattern (type, severity, associated injury), risk factors and clinical consequences. While mobile and active young adults were at risk of outdoor trauma, the report on penile trauma in the paediatric population is rare and usually focussed on sexual trauma. Penetrating trauma has been more extensively studied in comparison to blunt penile trauma despite the significance of the latter in the paediatric population. Injury severity classification is not available for most studies limiting their usefulness in the universal comparison of trauma severity and injury prognostication. There is a diversity in the burden and presentation of penile trauma. Available research studies are limited in the paediatric population, mostly focussed on penile fracture in adults and generally devoid of a standardised penile trauma severity description. Additional studies with a specific focus on penile trauma are required to characterise aetiological risks and injury severity across the legal age of maturity.

A review of the literature and proposed algorithm for penile fracture management

INTRODUCTION

In the management of penile fractures, immediate surgical repair has resulted in better outcomes when compared with a conservative approach; however, there is currently no consensus on the treatment of patients presenting beyond the immediate period (>24 hours) following injury.

OBJECTIVES

To examine the latest literature on management strategies in penile fracture and propose an optimal algorithm for the treatment of patients with delayed presentation.

METHODS

A comprehensive search was conducted following the PRISMA-P 2020 guidelines. A search was performed in several databases with the following strategy: ("Penile fracture" OR "fracture of penis" OR "rupture of corpora cavernosa" OR "rupture of tunica albuginea") AND (management OR treatment OR surgery OR "surgical reconstruction" OR "surgical repair"). This resulted in 108 relevant articles. Two independent reviewers screened these articles according to the inclusion criteria. Full-text review of 56 articles was performed, and ultimately 20 studies were selected. Measures included the use of diagnostic imaging, timing of surgical repair (immediate, <24 hours after injury; delayed, >24 hours), surgical approach, and long-term complications (ie, erectile dysfunction and penile curvature).

RESULTS

The review highlighted the benefits of immediate surgical repair in penile fractures, demonstrating improved patient outcomes. Furthermore, it found that surgical repair should be considered even in cases with delayed presentation (>24 hours after injury). To better evaluate the long-term impact of delayed surgical intervention on patient outcomes, we recommend standardized postoperative follow-up, with routine assessments of erectile function and penile curvature.

CONCLUSION

Contemporary literature suggests that immediate and delayed surgical repair of penile fractures leads to adequate postoperative outcomes, and patients presenting >24 hours after injury should still be considered for surgery.

Role of penile rehabilitation through daily intake of 5 mg tadalafil on erectile dysfunction after different presentations of penile fracture: a prospective case-control study

PURPOSE

We aimed in the current study to identify the predictive factors of ED occurrence in healthy individuals following penile fracture surgical repair as well as the effect of penile rehabilitation in the form of daily tadalafil 5 mg intake for 1 month for patients who suffered from ED after penile fracture incident.

METHOD

The current study was a prospective case-control study. Twenty-five patients were enrolled into the study starting from January (2022) to February (2023). Furthermore, time of presentation was determined, and length of tear intra-operative was measured, and then, a follow-up 1 week postoperatively in the outpatient clinic was conducted. All patients were instructed to start intercourse at least 2 weeks after the first visit provided that the wound epithelialized. Potent patients returned back home. A rehabilitation course of daily tadalafil 5 mg for 1 month was prescribed for patients who started complaining of ED that was confirmed by evaluation with the Arabic validated version of the international index of erectile function (ArIIEF-5). The rehabilitation therapy was terminated by resumption of normal erectile function. Thus, re-evaluation with the ArIIEF-5 was determined according to their response to therapy. Also, the patients were evaluated by hospital anxiety and depression scale (HADS) before and after penile fracture repair.

RESULTS

The current study had demonstrated that a 1% increase in age determines an increase in odds ratio for post-penile fracture ED with 73.6% and 1 cm increase in the length of tear determines an increase in odds ratio for post-penile fracture ED with 20.04 times.

CONCLUSION

The current study enhances the proper counseling of these patients prior to repairing the defect about the probability of ED occurrence as well as initiating early penile rehabilitation to help these patients resuming their normal sexual activity as soon as possible.

Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes

Background

Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture.

Aim

To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures.

Methods

Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes.

Outcomes

Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair.

Results

Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4 years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037).

Clinical Implications

Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period.

Strengths and Limitations

The study's retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function.

Conclusion

These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.

Delayed approach of a penile fracture with encapsulated hematoma

Penile fracture (PF) is defined as the rupture of the tunica albuginea (TA) of the corpora cavernosa (CC) caused by trauma to the erect penis. We present a case and clinical evolution of the delayed approach of PF. Physical examination showed a ventral rounded mass in the middle surface of the penile shaft, associated with mild discoloration and edema. Surgery was performed with a vertical penoscrotal incision. We found an encapsulated hematoma on the right ventral mid penile shaft connected at its base to an approximate 1 cm transverse defect on the TA and we performed debridement and excision of the hematoma. Tunical defect was repaired with PDS 3/0 simple suture. The patient had a great postoperative evolution without local complications. The early diagnosis and surgical treatment reaches better functional results, with maintenance of erectile function in patients with penile fracture.

Penile fracture following sexual intercourse; A case report and literature review

INTRODUCTION

Penile fracture is very uncommon urological condition. Sexual intercourse in most areas remains the major causative entity. Diagnosis is merely through clinical history, signs and symptoms. Surgical management has emerged as the gold standard option for penile fracture.

CASE PRESENTATION

we present a case of a young man who sustained penile fracture during sexual intercourse. It involved the left corpora cavernosum and early surgical repair was done successfully.

DISCUSSION

Penile fracture during sexual intercourse is due to impaction of erected penis against the female perineum. It's mostly unilateral but also bilateral with or without involvement of urethra. Investigations such as retrograde urethrogram, ultrasound, MRI and urethrocystoscopy can be done for assessment of severity of the injury. Early surgical repair of the injury has yield better outcome in both sexual and voiding function.

CONCLUSION

Penile fracture being rare urological condition but sexual intercourse has remained the major risk factor. Early surgical intervention is gold standard for its management as it's associated with very minimal long term complication.

First Two Cases of Conservative Treatment for Extreme Proximal Penile Fracture of the Corpora Cavernosa

Penile fracture is a urological emergency, and surgery is usually recommended to prevent complications. However, proximal locations are scarce and not well investigated. We present two rare penile fractures involving the proximal corpora cavernosa with an original conservative strategy to manage this clinical presentation. Twenty-five- and thirty-eight-year-old men with no previous medical history were admitted to the emergency room for penile trauma during sexual intercourse a few months apart. Both presented with "butterfly pattern" ecchymosis with a palpable hematoma on the perineum. They had no hematuria or voiding dysfunction. Ultrasound found a hematoma and a tear of the proximal corpus cavernosum for the younger one. Then, an MRI confirmed a longitudinal fracture of the right corpus cavernosum for the first patient and left for the second, without urethral injury. In agreement with the patients facing this atypical presentation, we proposed a conservative treatment with analgesics, monitoring, and advice to stop sexual activity for three weeks. After six weeks and four weeks, respectively, we performed a clinical evaluation and a second MRI that found no residual tear or hematoma. The IIEF-5 questionnaire was 24/25 and 25/25. The patients were clinically symptom-free at 8 and 11 months of follow-up. Extreme proximal fracture of the corpus cavernosum can be managed conservatively in selected situations. MRI is useful for decision-making by confirming the diagnosis and location to avoid surgery.

Comparison of early period sexual function parameters between surgical repair and conservative treatment after penile fracture

INTRODUCTION AND OBJECTIVES

Comparison of early period sexual function parameters in patients who had surgical repair and conservative follow-up after penile fracture and the evaluation of surgical intervention time on these parameters were planned in this study.

MATERIALS AND METHODS

Total of 26 patients who were treated for penile fracture were evaluated. 19 patients had surgical repair and 7 patients had conservative treatment. Sexual function and erectile dysfunction (ED) degree of the patients before penile fracture and in the 12th week after fracture were evaluated with 5-question International Index of Erectile Function (IIEF-5) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile(SEP) 2 and SEP 3. Parameters showing sexual function before and after the fracture were compared.

RESULTS

In both groups, a significant change was detected in IIEF-5 score, EHS, SEP-2 and SEP-3 parameters of the patients measured after penile fracture compared to the values before the fracture (all parameters, p<0.05). No difference was detected in the parameters measured before and after the fracture among surgical repair and conservative treatment groups (all parameters p>0.05). Mean time passing until the surgery after fracture was measured as 9.6±6.85h in 19 patients who had surgery.

CONCLUSION

A difference wasn't detected in sexual parameters in conservative treatment and surgical repair groups in this study. As a significant decrease was observed in sexual function parameters even in conservative treatment cases without sudden detumescence and tunica albuginea rupturing, we think that quick surgical exploration would be useful in cases considered to have penile fracture.

Severe penile fracture with bilateral corpus cavernosum rupture, complete urethral rupture and scrotal haematoma associated with sexual intercourse: A case report

INTRODUCTION AND IMPORTANCE

Despite the fact that a penile fracture is a rare emergency, it can cause morbidity in the patient, especially in terms of sexual life. If cases are not properly managed, irregularities in the penis will emerge, leading to more complicated problems. We present a case report of severe penile fracture associated with sexual intercourse.

CASE PRESENTATION

A 50-year-old man complained of soreness in his penis during sexual intercourse. The patient also has urethrorrhagia and is unable to urinate. Physical examination reveals the "Eggplant Deformity" in the penis. The operation was carried out and revealed bilateral corpus cavernosum rupture, complete urethral rupture, and ruptured Buck's fascia. The corpus cavernosum and other structures were repaired primarily, followed by an end-to-end anastomosis of the urethra. Four months later, the patient had no serious complaints, only a minor penis deviation. He can easily void and having intercourse.

CLINICAL DISCUSSION

In most situations, the penile fracture can be determined nearly entirely based on the patient's medical history and physical examination. In dubious circumstances, further tests such as ultrasonography and MRI can be conducted. If a penile fracture is discovered, surgery should be undertaken. Ruptures of the corpus cavernosum, tunica albuginea and Buck's fascia can be sutured primarily. The urethral can be reconstructed using an end-to-end anastomosis. Scrotal haematomas should be evacuated and drained to prevent persistent scrotal haematomas.

CONCLUSION

Immediate surgery in cases of severe penile fracture provides good outcomes for erectile function, micturition and sexual intercourse with minimal complications.

Consequences of penile fracture: Complications and long-term functional outcomes

INTRODUCTION

Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center.

MATERIALS AND METHOD

Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5 and morphological alterations by direct questions to patients.

RESULTS

A total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4% vs. 80%, p < 0.05). Only 1 patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and 1 patient with previous urethral injury presented urethral stricture.

CONCLUSION

In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare.

Double penile fracture without urethral injury presenting after 7 days

Penile fracture is the sudden rupture of the tunica albuginea of an erect penis due to blunt trauma. It is an uncommon uropathology which characteristically occurs when one or both of the turgid penile corpora cavernosa forcefully snap under an abrupt blunt trauma, usually during an aggressive sexual intercourse or noncoital manipulation. In the majority of cases, diagnosis is clinical. Surgical repair irrespective of the time of presentation results in accelerated recovery, reduced morbidity, and fewer short and long-term complication rates. We report the case of a 35-year-old banker who sustained a bilateral rupture of the tunica albuginea without urethral injury during a heterosexual intercourse. He presented 7 days after the trauma to our facility following the persistence of symptoms despite conservative management with herbal medicine. Following a clinical diagnosis of penile fracture, he had penile exploration under regional anesthesia using a degloving subcoronal incision. He subsequently had repair of both corporal tear after clot evacuation. The postoperative period was uneventful, and he was discharged on the 3^rd day after the surgery. He had been followed up for 2 years with good erectile and functional outcomes. This case report reiterates the fact that late presentation is not a barrier to surgical management and good outcome.

Penile fracture: Tertiary care center experience and long-term complications after immediate repair

BACKGROUND

In the literature, there is not sufficient data on factors affecting the development of complications in patients with penile fracture after early surgical intervention.

OBJECTIVES

To investigate the predictors of long-term complications in patients who underwent immediate surgical repair for penile fracture.

MATERIALS/METHODS

This clinical study included a total of 31 cases of penile fracture in which surgical treatment was performed within the first 24 hours and penile fracture was confirmed during the operation. The patients with and without late complications were compared in terms of parameters such as age, tear size of the tunica albuginea of the penis, bilateral involvement of the corpora cavernosa involvement, urethral injuries, and duration from penile fracture to surgery.

RESULTS

The median age of the patients was 42 (interquartile range [IQR]: 34-51) years. The median time from penile fracture to surgery was 13 (8-18) hours. The median tear size was 16 (11-21) mm. Late complications were seen in 13 (41.9%) patients in the postoperative period. Erectile dysfunction (ED) developed in five (16.1%) patients in the postoperative period. There was no statistically significant relationship between age, tear size, time from penile fracture to surgery, and bilateral corporeal involvement in terms of ED development. Painful erections, penile deviations, urethral strictures, tunical scars, and re-fracture were the other late complications. There was a significant relationship between the development of any complication and time from penile fracture to surgery (p = 0.028) and tear size (p = 0.031). In the receiver operating characteristic analysis of complication development, the cut-off value for the time from penile fracture to surgery was 13.5 hours.

DISCUSSION AND CONCLUSION

We found that the longer time interval between penile fracture and surgery worsened the patient outcomes. In addition, tear size was determined to be a predictor for long-term complications. In our opinion, early treatment of penile fracture can prevent severe complications in these cases. This article is protected by copyright. All rights reserved.

Self-Induced Trauma to the Genitalia: a Review of the Literature and Management Schemes

PURPOSE OF REVIEW

Self-induced genital trauma is rare, and prompt and evidence-based early intervention can improve the urinary and sexual function of these complex patients. This review has surveyed current literature and treatment trends to evaluate the clinical approach to managing genital trauma.

RECENT FINDINGS

A literature review was performed regarding self-induced genitalia trauma and trauma management between 2000 and 2019 using MEDLINE® database, the Cochrane Library® Central Search, Web of Science, and Google Scholar. In total, 42 articles were considered relevant and included in this review. Self-induced trauma can be appropriately managed with a multidisciplinary approach. Treatment goals are to preserve urinary, sexual, and reproductive function. Specific evaluation includes mechanism of injury, imaging, and determining the extent of injury and surgical repair, if indicated. Due to the rarity of these injuries and their emergent nature, much of the management is based on retrospective data. Further research is needed to improve long-term functional outcomes in trauma patients.

The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy

PURPOSE OF REVIEW

To review the current literature on acute management of traumatic penile fracture, with a specific discussion of those injuries following collagenase clostridium histolyticum (CCH) injections for the treatment of Peyronie's disease.

RECENT FINDINGS

The immediate repair of traumatic penile fracture injury is associated with significantly better prognosis for long-term sexual health. Corporal disruption following CCH administration has several distinct features, and the trend is to manage these patients conservatively in the absence of urethral injury. Traumatic penile fracture repair continues to have excellent results when performed immediately following injury. The post-CCH treatment setting portends increased difficulty during surgical management and can be successfully managed in most cases by conservative measures.

Sexual Dysfunction Among Men Who Have Sex with Men: a Review Article

PURPOSE OF REVIEW

The goal of this review article is to evaluate sexual dysfunction among men who have sex with men (MSM).

RECENT FINDINGS

Men who have sex with men are commonly affected by sexual dysfunction. Often sexual dysfunction in MSM will significantly impact their psychological well-being perhaps even more than their heterosexual counterparts. Despite the frequency and high impact of sexual dysfunction in MSM, access to appropriate care may be limited. It is important for urologists, especially sexual medicine clinicians, to be aware of and comfortable with differences in sexual practices of MSM. Penile pathology in this patient population will negatively affect their quality of life and well-being. Therefore, it is important to properly assess and treat these patients.