(196) Advanced Surgical Management for the Ramifications of Neglected Penile Fracture with Pericardial Graft Reinforcement
Authors: Khalaf Alla K , Thompson L , Wang R 
Published: March 2024

Abstract

Introduction
Penile fractures occur when the tunica albuginea, a fibrous layer surrounding the corpora cavernosa, ruptures during sexual intercourse or masturbation. These incidents, although rare, are considered serious emergencies. Failure to address them promptly can result in complications such as erectile dysfunction, penile curvature, and hematoma. Unfortunately, cases often go unreported due to embarrassment or fear, resulting in delayed medical attention. Diagnosing penile fractures is mainly clinical, and treatment options depend on the timing of presentation.

Objective
To emphasize the importance of early medical attention and surgical intervention in the context of penile fractures, with the goal of preventing or reducing the occurrence of long-term complications.

Methods
A 55-year-old male developed a query penile fracture during intercourse. Initially, he experienced a popping sound with no visible signs of injury nor loss of erection. Two weeks later, he sought medical advice due a penile bump development accompanied by painful erections. Conservative management was provided with ice, non-steroidal anti-inflammatory drugs, and sexual abstinence. However, he later presented with a penile mass and curvature affecting his penetration during intercourse. A penile Doppler ultrasound revealed a fibrotic hematoma with a complex cystic lesion measuring 23.1 mm x 18.1 mm x 28.3 mm. The patient underwent a complex penile mass excision, tunica albuginea plication with pericardium graft reinforcement. The surgery involved excising scar tissue, removing the underlying fibrotic hematoma and cystic lesion, correcting the curvature, and reinforcing the weakened tunica albuginea with pericardium graft (Tutoplast, IOP Ophthalmics, Costa Mesa, CA, USA) (Figures 1–3). Histopathology reported grossly “a penile fibrotic mass with irregular dark brown firm cystic structure filled with yellow-tan necrotic tissue”. Microscopic description showed “a fibrous capsule with central hemorrhage and fibrin”.

Results
The patient had a successful procedure & uneventful smooth recovery. During 6 & 12 months follow-up, there was no long-term complications, he reported resolved curvature and satisfactory sexual intercourse Surgical treatment is recommended for penile fractures to achieve satisfactory results and restore sexual function. Various graft materials can be used to reinforce penile defects. Tutoplast (processed allograft tissue from cadaveric pericardium) has shown excellent results in Peyronie's curvature repair. The efficacy of bovine pericardium compared to Tutoplast in urologic surgeries is uncertain. In this particular case, Tutoplast was chosen due to its accessibility and the surgeons expertise in Peyronie's repair and penile prosthesis implantation.

Conclusions
This case report highlights the formation of a fibrotic hematoma resulting from delayed penile fracture presentation, which was managed through mass excision & correction of curvature. To date, there is no literature mentioning fibrotic hematoma formation as a consequence of neglected fracture presentation. Prompt medical attention with low threshold for early surgical intervention should be sought for suspected penile fractures to avoid potential long-term complications and improving their quality of life.

Disclosure
No.