Penile Fracture Treatment in Singapore

Penile fracture treatment involves emergency surgical repair of a torn tunica albuginea, the fibrous tissue surrounding the corpora cavernosa (erectile chambers) of the penis. This injury typically occurs during vigorous sexual activity when the erect penis slips out and forcefully strikes the partner’s perineum or pubic bone, though it can also happen during aggressive masturbation or rolling over onto an erect penis during sleep.

The treatment aims to repair the torn tissue, evacuate blood clots, and restore the anatomical integrity of the penis. Immediate surgical intervention is crucial as delays can result in penile curvature, erectile dysfunction, or other long-term complications. The procedure involves identifying and suturing the tear in the tunica albuginea, and if present, repairing any associated urethral injuries. Success rates are high when surgery is performed within 24-48 hours of injury, with most patients regaining normal erectile and urinary function.

Immediate Treatment Indicators

• Sudden “popping” or “cracking” sound during sexual activity
• Immediate loss of erection following the injury
• Severe penile pain and rapid swelling
• Penile deformity or abnormal angulation
• Dark bruising of the penile shaft (eggplant deformity)
• Blood at the urethral opening (indicating possible urethral injury)
• Difficulty or inability to urinate
• Visible penile hematoma

When Surgery is Essential

• Confirmed tear in the tunica albuginea on clinical examination
• Imaging evidence of penile fracture (ultrasound or MRI)
• Associated urethral injury requiring repair
• Large hematoma causing significant deformity
• Persistent pain and swelling despite conservative measures

The diagnosis of penile fracture is primarily clinical, based on history and physical examination. While some minor penile injuries may be managed conservatively, true penile fractures require surgical intervention. Delaying treatment beyond 24-48 hours significantly increases the risk of complications. Any man experiencing symptoms consistent with penile fracture should seek immediate emergency medical evaluation by a urologist.

Immediate Surgical Repair

The standard treatment for penile fracture is immediate surgical exploration and repair. This approach involves making an incision to access the injury site, evacuating hematomas, identifying the tear in the tunica albuginea, and performing meticulous repair with absorbable sutures. The surgeon carefully inspects both corpora cavernosa and the corpus spongiosum to ensure all injuries are identified and repaired.

Degloving Technique

For cases where the fracture site is unclear or multiple tears are suspected, surgeons may use a circumferential subcoronal incision to “deglove” the penis. This technique provides exposure of the entire penile shaft, allowing thorough inspection of all erectile bodies and accurate repair of all injuries. While more invasive, this approach ensures no injuries are missed.

Urethral Repair Considerations

When urethral injury accompanies the penile fracture (occurring in 10-20% of cases), simultaneous urethral repair is performed. This may involve primary suturing of partial tears or more complex reconstruction for complete transections. A urinary catheter is typically placed to allow healing.

Technology & Equipment Used

Modern surgical repair utilises fine absorbable sutures, surgical loupes for magnification, and sometimes intraoperative ultrasound to identify subtle injuries. Some centres employ cavernosography (injection of contrast into the erectile chambers) to confirm the diagnosis before surgery, though this is not always necessary.

Pre-Treatment Preparation

Upon arrival at the emergency department, immediate assessment includes vital signs, pain management, and urological consultation. Blood tests are performed to check for infection and assess fitness for surgery. The penis is examined carefully, and ice packs may be applied to reduce swelling. Patients are kept fasting in preparation for emergency surgery. Informed consent is obtained, explaining the procedure, risks, and expected outcomes. Antibiotics are administered to prevent infection.

During the Procedure

The surgery is performed under general or spinal anaesthesia. A urinary catheter is inserted to decompress the bladder and identify any urethral injury. The surgeon makes an incision (circumferential subcoronal or direct over the fracture site) to expose the injury. Blood clots are evacuated, and the tear in the tunica albuginea is identified. The defect is closed with interrupted absorbable sutures, ensuring watertight closure. If urethral injury is present, this is repaired simultaneously. The procedure typically takes 1-2 hours, depending on injury complexity.

Immediate Post-Treatment

Following surgery, patients are monitored in recovery until fully awake. Pain medication is provided for comfort. The surgical site is dressed, and the penis may be wrapped in light compression bandaging. Most patients can be discharged the same day or after an overnight stay. Instructions are given for wound care, activity restrictions, and follow-up appointments. If a urinary catheter was placed, instructions for catheter care are provided. Patients receive prescriptions for pain medication and antibiotics.

First 24-48 Hours

Patients should rest and avoid strenuous activities. Ice packs can be applied intermittently to reduce swelling (20 minutes on, 20 minutes off). Pain is typically managed with oral medications. The surgical dressing should be kept clean and dry. Patients should monitor for signs of infection such as increasing pain, fever, or discharge. Normal activities like walking are encouraged to prevent blood clots. Erections should be suppressed with medication if necessary to prevent strain on the repair.

First Week

Daily wound care involves gentle cleaning and dressing changes as instructed. Swelling and bruising typically peak at 2-3 days then gradually improve. Patients can usually return to desk work after 3-5 days. Follow-up appointment is scheduled to check wound healing and remove any non-absorbable sutures. Antibiotics should be completed as prescribed. Patients should continue to avoid sexual activity and prevent erections. Light activities can be gradually resumed.

Long-term Recovery

Complete healing typically occurs within 6-8 weeks. Sexual activity can usually resume after 6 weeks with surgeon approval. Some patients may notice mild penile curvature or plaque formation at the repair site, which often improves over time. Regular follow-up appointments monitor for complications such as erectile dysfunction or penile deformity. Most men regain full erectile function within 3-6 months. Psychological support may be beneficial for anxiety related to resuming sexual activity.

Immediate surgical repair of penile fracture offers significant benefits compared to conservative management. Primary repair restores the anatomical integrity of the penis, maintaining its straight appearance and preventing permanent deformity. Studies show that early surgical intervention results in preservation of erectile function in over 90% of cases, compared to only 50-60% with conservative treatment.

The procedure prevents long-term complications such as penile curvature (Peyronie’s disease), painful erections, and erectile dysfunction. Surgical repair also addresses any associated urethral injuries, preventing urinary complications like strictures or fistulas. Most patients report satisfaction with cosmetic outcomes and maintain their pre-injury sexual function. The psychological benefits of successful treatment include reduced anxiety about sexual performance and improved quality of life. Early intervention typically results in faster recovery times and earlier return to sexual activity compared to conservative management.

Common Side Effects

Temporary swelling and bruising are expected after surgery and typically resolve within 2-3 weeks. Mild pain at the incision site is normal and managed with oral pain medication. Some patients experience temporary changes in penile sensation, which usually improves as nerves heal. Minor bleeding or oozing from the incision may occur in the first few days. Temporary difficulty with urination may occur if a catheter was placed.

Rare Complications

Infection at the surgical site occurs in less than 5% of cases and is treated with antibiotics. Wound dehiscence (opening of the surgical incision) is rare but may require revision surgery. Some patients develop penile curvature despite repair, though this is usually mild. Erectile dysfunction occurs in 5-10% of cases, often responding to medical treatment. Urethral stricture may develop if urethral injury was present. Painful nodules or plaques at the repair site occasionally form but often improve with time.

Complications are minimised through meticulous surgical technique, appropriate antibiotic use, and proper post-operative care. Choosing an experienced urologist familiar with penile fracture repair significantly reduces complication risks.

The cost of penile fracture treatment varies based on several factors including the complexity of the injury, need for urethral repair, type of anesthesia, and hospital stay duration. Emergency surgery typically incurs additional charges compared to elective procedures. The total cost includes surgeon fees, anesthesia, operating theatre time, hospital accommodation, medications, and follow-up care.

The surgical fee generally covers the initial consultation, procedure, and immediate post-operative management. Additional expenses may occur if complications arise or if revision surgery becomes necessary. Patients are encouraged to discuss cost details with their healthcare provider for transparency. Consulting an experienced urologist in Singapore ensures proper surgical care, which helps achieve optimal recovery and prevents costly long-term complications.