Abstract

Aim: Penile fracture is a urological emergency requiring urgent surgical intervention. While early repair within the first 24-48 hours is considered the gold standard, the impact of surgical timing is not established and long-term outcomes regarding erectile function are poorly understood due to relatively short follow-up and inconsistent use of validated assessment tools. We aimed to evaluate long-term erectile function outcomes after penile fracture surgery and to determine clinical factors associated with erectile dysfunction.
Materials and Methods: This retrospective cohort study included 38 patients who underwent surgery for penile fracture between January 2014 and December 2023. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire before surgery, at 6 months, and 1, 2, and 3 years after surgery.
Results: The mean follow-up period was 66.17±40.22 months. The preoperative IIEF-5 score was 22.50±1.99, which decreased to 17.63±3.40 at 6 months and remained at 19.58±2.64 at 3 years, showing a persistent decrease (p=0.001). The fracture-to-surgery time interval was negatively correlated with the change in IIEF-5 score. Postoperative angulation was observed in 21.1% of patients and was significantly associated with mid-shaft fractures (p=0.023). Nodule formation was observed in 21.1% of cases and showed a strong relationship with delayed surgery (median 42 hours vs. 8 hours, p=0.001).
Conclusion: Delay in surgery is the most important modifiable risk factor and longer delays have progressively adverse effects. These findings indicate that urgent surgical intervention is critical in penile fracture.

Key words: Penis/surgery, tunica albuginea/injuries, sexual dysfunction, physiological, penile erection, time factors, retrospective studies