Background Penile fracture is a rare condition characterised by disruption of the tunica albuginea typically caused by blunt trauma to a tumescent penis. It is a urological emergency that requires prompt diagnosis with a view to urgent treatment. The current global consensus on management of penile fractures is urgent surgical exploration and repair of the tunical defect. This is recommended with a view to minimise the risk of long‐term functional outcomes, mostly relating to sexual dysfunction. However, the lack of high quality data on ‘immediate’ versus ‘delayed’ surgical repair groups in terms of long‐term outcomes means that the exact timing of surgical repair is still debatable. Case Presentation A 50‐year‐old healthy sexually active male presented after a snapping sound during sexual intercourse 90 minutes before, followed by detumescence and penile pain. A tunical breach in the left proximal penile shaft was diagnosed clinically and confirmed on emergency ultrasound. The patient tested positive for COVID‐19 and, given the perioperative risk of morbidity and mortality, it was decided to delay surgical repair. 10 days after the injury, following a negative COVID‐19 test, he successfully underwent circumferential degloving, circumcision and closure of the tunical defect. Upon review at 4 and 20 months post‐op, there was no scarring or penile curvature, and he was having normal painless erections and penetrative sexual intercourse. Conclusions This is a case of early presentation of penile fracture in a healthy sexually active male, where surgical repair was delayed by 10 days because of COVID‐19 infection, with positive short and medium term outcomes. It reinforces the idea that penile fracture patients who present late should still be offered surgery and that delaying surgery to optimise a patient′s condition may be an acceptable approach. However, more research is needed into timing of surgical repair and its effect on long‐term functional outcomes.
Rodgers et al. (Thu,) studied this question.