(152) Determinants of Surgical Delay and Functional Impact in Penile Fracture: A Real-World Tertiary Center Cohort

Introduction Prompt surgical repair of penile fracture (PF) optimizes functional recovery, yet delays remain common. Identifying what drives surgical delay and how it affects postoperative outcomes is essential to streamline care pathways and improve patient care. Objective To identify determinants of surgical delay in patients with PF and to assess its association with changes in erectile and urinary function using validated score variation and clinically meaningful thresholds. Methods We retrospectively reviewed 33 patients surgically explored for suspected PF (2021–2025). By October 2025, 25 (76%) had follow-up. Collected variables included etiology, clinical/imaging findings, and three timing metrics: (1) trauma→first evaluation (not necessarily urological), (2) first evaluation→surgery, (3) trauma→surgery. Functional endpoints in the 25 patients with paired scores were ΔIIEF-5 = post−pre (negative = worse) and ΔIPSS = post−pre (positive = worse). Clinically relevant change followed minimal clinically important difference (MCID) thresholds (IIEF-5 decline ≥4; IPSS increase ≥3). Surgical delay was defined as more than 12 h, with more than 24 h as sensitivity. Group comparisons used Mann–Whitney U and Fisher’s exact; associations between continuous timing variables and Δ-scores used Spearman’s ρ. Results Mean age was 45 years (SD 13). Sexual intercourse was the most frequent etiology (88%). Median time from trauma to first evaluation was 4.0 hours (interquartile range 3.0–9.0), and from trauma to surgery 16.5 hours (11.0–21.0). The median interval from first evaluation to surgery was 12 hours (8–15), longer among transferred patients but without statistically significant difference (p above 0.05). Twenty-three patients (69.7%) underwent surgery more than 12 hours after trauma, and six more than 24 hours. Formal radiology ultrasound was associated with longer time to surgery (median 18.0 vs 7.5 hours; Mann–Whitney p=0.0012) and a higher proportion of repairs beyond 12 hours (Fisher p=0.0025). Interhospital transfer was required in 72.7% (24/33), more frequent among delayed repairs, but not associated with delay (p=0.41). Longer time from trauma to first evaluation correlated with longer trauma-to-surgery time (r=0.51, p=0.003) and with a higher frequency of repairs beyond 12 hours (Fisher p lower than 0.05). Time from first evaluation to surgery showed a similar association with total delay (r=0.46, p=0.006). In the outcomes subset (n=25; mean follow-up 21 months, SD 13), longer time to surgery tended to be associated with worse change in IIEF-5 score (r=−0.332, p=0.105) and showed no association with change in IPSS (r=0.019, p=0.930). Time to first evaluation correlated with change in IIEF-5 (r=−0.58, p=0.002), but not with change in IPSS. By MCID criteria, 28% of patients had meaningful erectile deterioration and 8% had worsening urinary symptoms. There were no significant differences in IIEF-5 or IPSS change by transfer status (both p=0.32). Clinical signs, urethral rupture and laceration size were not significant predictors of delay or functional change (all p values above 0.05). Conclusions Approximately 70% of PF repairs occurred more than 12 hours after trauma. Longer time to evaluation and use of formal ultrasound were linked with surgical delay and a trend to worse outcomes. Prioritizing early recognition, referral and avoiding routine ultrasound in classic cases may shorten repair time. Disclosure No