(112) Multicenter Experience in Penile Fracture Management: A 10-Year Clinical Analysis from Azerbaijan

Introduction Penile fracture, characterized by disruption of the tunica albuginea during erection, has been widely documented in Middle Eastern and Mediterranean populations. However, epidemiological and surgical outcome data from Azerbaijan are currently unavailable. This study provides multicenter evidence regarding presentation patterns, operative strategies, and clinical sequelae among affected patients over ten years. Objective To evaluate clinical presentation, diagnostic pathways, and surgical outcomes of penile fracture cases managed across multiple centers in Azerbaijan over a 10-year period, and to assess complication rates, functional recovery, and the impact of delayed presentation on postoperative results Methods This retrospective multicenter study included patients diagnosed with penile fracture between January 2014 and December 2024 across four tertiary urological centers in Azerbaijan. All patients presented with a clinical history suggestive of tunical rupture, characterized by sudden penile pain, “cracking” sound, rapid detumescence, and subsequent swelling or hematoma formation. Demographic data, risk factors, trauma mechanism, time to hospital admission, diagnostic imaging, operative technique, perioperative findings, and postoperative outcomes were recorded. Preoperative evaluation included physical examination and penile ultrasonography in suspected complex cases; urethroscopy was performed when urethral injury was suspected. Surgical repair was performed under general or spinal anesthesia. A circumferential subcoronal incision with penile degloving was primarily preferred; region-specific incisions were used selectively. Hematoma evacuation, tunical defect identification, and closure with absorbable sutures were performed, followed by artificial erection to confirm watertight repair and rule out residual deformity. Urethral injuries, when present, were repaired primarily or managed with catheter drainage. Postoperatively, patients received prophylactic antibiotics, analgesia, and anti-erection therapy for three weeks. Sexual abstinence was advised for 40 days. Erectile function was assessed preoperatively and at the 3-month follow-up using the International Index of Erectile Function (IIEF-EF domain). Results A total of 63 patients were evaluated, with a mean age of 34 years (17–69). Sexual intercourse was the predominant cause (55.5%), followed by accidental trauma (12.7%) and self-manipulation injuries (7.9%). The mean presentation time was 36 hours, and the average tunical defect size was 1.5 cm. Urethral injury was identified in 6 patients (9.5%). 1 patient had urertral perforation. Surgical repair was performed in 55 patients (87.3%), while 8 (12.7%) received conservative management. Postoperative complications included localized abscess in 2 patients and transient pain in 4 patients. Two patients (3.1%) developed erectile dysfunction and were managed with PDE5-inhibitor therapy. One patient (1.6%) developed a mild penile curvature, requiring surgical correction. The mean 3-month IIEF-EF score was 19 (range 8–28) Conclusions Penile fracture remains a time-sensitive urological emergency in which early diagnosis and prompt surgical intervention yield favorable functional outcomes. In this first multicenter experience from Azerbaijan, timely repair resulted in high erectile function preservation and low complication rates. Despite occasional delayed presentation, most patients achieved satisfactory recovery. These findings emphasize the importance of early referral, standardized surgical techniques, and structured postoperative rehabilitation in optimizing functional results. Disclosure No