Imaging findings in suspected penile fracture: alternative diagnoses and surgical correlation

Abstract Objectives The primary objective is to compare the imaging and surgical findings in a cohort of patients with suspected penile fracture (PF) Methods Retrospective cohort study of all patients with suspected PF over an 11-year period at a tertiary referral andrology centre. All dedicated presurgical imaging with ultrasound (US) and MRI was analysed and correlated with intraoperative findings; alternative diagnoses were recorded. Results 193 patients were included. 104 (54%) had alternative diagnoses to PF including dorsal vein rupture and haematoma. 99 (51%) underwent surgical exploration of which 89 (46%) had PF. US correctly confirmed the presence and marked site of fracture in 92% of cases. MRI was primarily used as a problem-solving tool (13 cases) and demonstrated a more extensive injury than US (12 cases). The reported size of tunical defect on imaging was a median of 7 mm (IQR 4-10) significantly smaller than on exploration, (median 20 mm, IQR 10-30) p 0.0001. Conclusion US has a high positive predictive value in the confirmation of penile fracture. MRI improves the detection and characterising the extent of injury. Imaging marking informs surgical incision but defect size is under appreciated on all imaging modalities. Advances in knowledge Penile imaging has a high positive predictive value to not only confirm the diagnosis of PF but to stage the extent of injury and mark the skin, which impacts the surgical technique. Alternative diagnoses to fracture are common and imaging could prevent unnecessary surgical exploration.