(240) Preoperative Ultrasound in Penile Fracture: Does Tunical Tear Length Predict Urethral Injury?

Introduction Penile fracture is predominantly a clinical diagnosis; expedited surgical exploration remains the standard of care. The literature and major guidelines support targeted urethral assessment when clinical signs are present (urethrorrhagia, hematuria, urinary retention). Ultrasound (US) is often used when presentation is not straightforward, while MRI may be considered in selected scenarios. Whether US-measured tunical tear length predicts urethral injury is unclear. Objective To determine whether tunical tear length on preoperative US (mm) is associated with urethral injury. Methods We conducted a retrospective cohort study (2021–2025) at a tertiary center including 33 surgically managed patients. US was performed in most cases; tear length analyses were restricted to examinations with a reported measurement in the radiology report. The primary outcome was urethral injury (yes/no), confirmed intraoperatively or by retrograde urethrography when indicated. Tear length was compared between patients with and without urethral injury using two-tailed Mann–Whitney tests. Exploratory analyses assessed (i) whether the availability of a length measurement was associated with urethral injury (Fisher’s exact), and (ii) whether orientation (transverse/longitudinal), laterality (right/left/bilateral), and longitudinal position (proximal/mid-shaft/distal)-when reported-modified the length–injury relationship (Fisher’s exact for interaction strata). Results Median tear length was 10 mm (interquartile range 8–13). Length did not differ between patients with and without urethral injury (p=0.870). The mere availability of a US length measurement was not associated with urethral injury (p = 0.205). Incorporating orientation, laterality, and longitudinal position in exploratory analyses did not reveal a consistent effect-modification pattern. Conclusions In this tertiary-care cohort, US tunical tear length showed no standalone predictive utility for urethral injury and no clinically relevant discriminative capacity. Clinically, these findings support clinic-driven urethral work-up (triggered by urethrorrhagia, hematuria, voiding difficulty, or intraoperative suspicion) rather than length-triggered pathways. US retains value as diagnostic support in equivocal presentations and for surgical planning, but length alone should not determine urethral evaluation. Future multicenter studies with larger samples and multivariable models integrating clinical features with morphologic US descriptors are warranted to test whether combined signatures outperform length alone for identifying urethral injury. Disclosure No