Because of the low incidence of penile fracture, many aspects of the diagnostic process and of the surgical and functional outcomes are rarely reported. To systematically review the current literature on the surgical management of penile fracture, focusing on etiology, diagnosis, functional outcomes, and postoperative complications. The present review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms penile fracture, fracture of penis, trauma of penis, rupture of corpora cavernosa, and immediate management of penile fracture was been carried out in the PubMed, EMBASE, Cochrane, SCOPUS, and Science Citation Index databases. Etiology of penile fracture, clinical presentation, types of radiologic investigations and their accuracy, surgical approach, suture material used for tunica repair, timing of surgical exploration, intraoperative findings, surgical complications, and functional outcomes. The total number of patients analyzed was 438, and the patients' an average age was 36 years. The most frequent reported cause of penile fracture was sexual intercourse (80% of cases). The most common finding at examination was a penile hematoma (97.5%). Although operator dependent, in experienced hands, ultrasonography was found to be a useful tool in confirming the location of the albuginea tear and identifying the presence of any concomitant urethral injury, helping the surgeon to choose the best surgical approach. Early surgical repair of a penile fracture was found to be a safe procedure, although long-term complications are not uncommon. Tertiary referral centers that managed a larger number of cases seemed to obtain more satisfactory long-term results with a significantly smaller number of complications. A low incidence of postoperative complications and full satisfactory functional outcomes are reported when early repair is performed in high-volume centers. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current Management of Penile Fracture: An Up-to-Date Systematic Review. Sex Med Rev 2018;6:253-260.

Objectives: To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria. Patients and Methods: We conducted a retrospective single‐centre analysis of 247 consecutive patients. The recruitment period was January 2001 to October 2015. A total of 328 inflatable PPs were implanted. A two‐staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora. Subsequently, cylinder(s) and pump placement was performed. A Dacron envelope was fitted around the proximal and distal aspect of the cylinder(s) to anchor the device to the pubic bone and to prevent apical protrusion. The outcomes measured were postoperative complications, eventual need for revision surgery, and long‐term survival of the implants. Patient and partner satisfaction rates were extrapolated from the administered non‐validated questionnaires. The data were analysed using non‐parametric tests, multivariate logistic regression analysis, and a Kaplan–Meier survival curve. Results: The mean follow‐up was 20 months. In all, 88% of patients were satisfied with the result, although only 77% used their device for sexual intercourse. The overall 5‐year device survival was 78%, with no one device being superior. Device infection occurred in 8.5% of patients with an overall revision rate of 43%. According to the multivariate logistic regression analysis, only type of phalloplasty significantly affected the infection risk ( P = 0.013). Conclusions: Implantation of a PP into a neophallus is a complex procedure but yields high satisfaction rates. Nevertheless, complication rates are high and patients must be warned that multiple revisions will be necessary throughout their lifetime.

Ghayda RA, et al. World J Mens Health. 2024 Jan;42(1):39-61. https://doi.org/10.5534/wjmh.230050

Objectives: To report the results from a prospective multicentric study of patients with Peyronie's disease ( PD ) treated with the ‘sliding’ technique ( ST ). Patients and Methods: From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end‐stage erectile dysfunction ( ED ) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function ( IIEF ) questionnaire, the Sexual Encounter Profile ( SEP ) Questions 2 and 3, and the Peyronie's disease questionnaire ( PDQ ) were completed preoperatively by all patients. At the follow‐up visits (at 3, 6 and 12 months), the IIEF , the SEP Questions 2 and 3, the PDQ , and the Erectile Dysfunction Inventory of Treatment Satisfaction ( EDITS ) were completed. The outcome analysis was focused on penile length restoration, and intra‐ and postoperative complications classified according the Clavien–Dindo Classification. Results: The mean (range) follow‐up was 37 (9–60) months. A malleable penile prosthesis ( PP ) was implanted in seven patients, while an inflatable three‐pieces PP was placed in the remainder. In the case of inflatable PP implantation, porcine small intestinal submucosa and acellular porcine dermal matrix were used to cover the tunical defects. While in patients undergoing malleable PP implantation, collagen‐fibrin sponge was used. The mean operative time was 145 min in the inflatable PP group and 115 min in the malleable PP group. There were no intraoperative complications. Postoperative complications included profuse bleeding requiring a blood transfusion in one patient (3.5%) on anticoagulation therapy for a mechanical heart valve (Grade II ) and PP infection requiring the removal of the device (7%) (Grade III ). There were no late recurrences of the shaft deformation. The postoperative functional data showed a progressive improvement in the score of all questionnaires, peaking at 12 months postoperatively. The mean (range) penile lengthening was 3.2 (2.5–4) cm and no patient reported recurrence of the curvature. Conclusions: The present series suggests that, in the hands of experienced high‐volume surgeons, penile length restoration with the use of the ST represents an effective option for end‐stage PD associated with ED and severe shortening of the shaft. Larger series and longer follow‐up will be required to fully establish the efficacy of this procedure.