(217) Revitalizing Penile Health: Advanced Surgical Approach for Treating Penile Mass Formation Resulting from Neglected Fractures, Enhanced with Pericardial Graft Reinforcement
Authors: Thompson L , Khalafalla K , Wang R 
Published: February 2024

Abstract

Introduction
Penile fractures are rare but serious emergencies caused by the rupture of the tunica albuginea during sexual activity. Prompt medical attention is crucial to prevent complications like erectile dysfunction, penile curvature, and hematoma. Delayed reporting due to embarrassment or fear can lead to further complications. Diagnosing penile fractures primarily relies on clinical examination, and treatment options depend on the timing of presentation. Seeking immediate medical help is vital to prevent long-term complications and ensure proper management.

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

Methods
This case report involves a 55-year-old male who experienced a penile fracture during intercourse. Initially, he had no hematoma, bruising, pain, or loss of erection. Two weeks later, he sought medical advice due to a penile bump and slightly painful erections. He was managed conservatively with ice, nonsteroidal anti-inflammatory medications, and abstinence from intercourse. Two months later, he presented to our clinic with complaints of a penile mass and curvature, affecting his erections and penetration. A penile Doppler ultrasound revealed a fibrotic hematoma with a complex cystic lesion measuring 23.1 mm × 18.1 mm × 28.3 mm on the right lateral mid-penile shaft. The patient underwent complex penile mass excision, tunica albuginea plication, and pericardium graft reinforcement. During the surgery, scar tissue and underlying fibrotic hematoma were removed (Figure 1). A complex cystic lesion on the right lateral mid-penile shaft was also excised (Figure 2). A tunica albuginea plication corrected the 30° left dorsal curvature. A pericardium graft (Tutoplast®, IOP Ophthalmics, Costa Mesa, CA, USA) reinforced the weakened tunica albuginea and covered the defect (Figure 3). Histopathology of the mass reported “a penile fibrotic mass, measuring 2 cm × 1.8 cm × 2.6 cm with an 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 and smooth recovery. At 6- and 9-month follow-up, he expressed satisfaction with no complications or long-term side effects. Erectile function was restored, and penile curvature resolved, enabling satisfactory penetrative intercourse. Surgical treatment is recommended for achieving satisfactory results and restoring sexual function in penile fractures. 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, but the efficacy of bovine pericardium remains uncertain. In this case, Tutoplast® was chosen for its accessibility and the surgeons' expertise in Peyronie's repair and penile prosthesis implantation, ensuring the best possible outcome.

Conclusions
This case report highlights fibrotic hematoma due to delayed penile fracture presentation, managed through mass excision and curvature correction. Currently, there is no literature available that discusses fibrotic hematoma formation from delayed penile fractures. Prompt medical attention crucial to avoid long-term complications. Early surgical management prevents erection loss, curvature, hematoma, or mass formation, improving quality of life for patients with penile fractures.

Disclosure
No.