ORIGINAL ARTICLE Penile injury and effect on male sexual function Z. Persec 1 , J. Persec 2 , D. Puskar 1 , T. Sovic 1 , Z. Hrgovic 3 & W. J. Fassbender 4 1 Department of Urology, Dubrava University Hospital, Zagreb, Croatia; 2 University Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia; 3 University Department of Gynecology, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany; 4 Hospital zum Hl. Geist Kempen, Academic Training Hospital of the Heinrich Heine University, Du ¨ sseldorf, Germany Introduction Traumatic injuries to the genitourinary tract are seen in 2.2–10.3% of patients admitted to hospitals (Archbold et al., 1981). The incidence of penile injuries has not been determined, but most case series include relatively small numbers of patients over many years (Archbold et al., 1981; Mohr et al., 2003). Penile trauma is seen in all age groups, most frequently in males aged 15–40 and is usu- ally caused by blunt injuries (80%), whereas 20% are due to penetrating lesions (Mydlo et al., 2002). In males, a direct blow to the erect penis may cause penile fracture, frequently occurring during consensual intercourse, which accounts for approximately 60% of penile fractures (Penson et al., 1992; Ecke, 2002). Accurate diagnosis and treatment of patients with penile injuries are of utmost importance. Penile fracture is caused by rupture of the cavernosal tunica albuginea and may be associated with lesions of the corpus spongiosum and urethra in 10–22% of cases (Nicolaisen et al., 1983; Tsang & Demby, 1992). Due to the tunica albuginea thickness in flaccid state (approximately 2 mm), blunt trauma to the penis does not usually cause tearing of the tunica when there is no tumescence and rigidity. In these cases, only subcutaneous haematoma may be seen. Predisposing factors include excessive force at coitus or manipulation, tunica albuginea fibrosclerosis and chronic urethritis (Bertini & Corriere, 1988; Karadeniz et al., 1996). Injuries to the penis may involve urethral damage, which should be investigated by retrograde urethrography (Gross, 1982; Tsang & Demby, 1992). The goal of surgery is to restore penile function and appearance. The operative repair of genital injuries involves appropriate irrigation, debridement and closure Keywords Male sexual function—penile injury—treatment Correspondence Zlatko Hrgovic, MD, PhD, Kaiserstraße 15, D-60311 Frankfurt, Germany. Tel.: +49 69 293000; Fax: +49 69 291697; E-mail: info@hrgovic.de Accepted: February 25, 2010 doi: 10.1111/j.1439-0272.2010.01072.x Summary Penile injury is common as an emergency and should be accurately diagnosed and treated. We analysed 22 patients with penile injury admitted to the emergency unit of Dubrava University Hospital during a 4-year period. According to the American Association for the Surgery of Trauma five-grade classification of penile injuries, there were 14 grade I, 6 grade II and 2 grade III cases. Diagnosis was mainly based on clinical and ultrasonography findings, and in some cases on cavernosography. Nineteen patients underwent immedi- ate surgery and three patients received conservative therapy. On outpatient fol- low up, sexual function was assessed by use of the 5-item International Index of Erectile Function (IIEF-5) test at 3 and 12 months of injury. At 3-month follow up, moderate, mild and no erectile dysfunction was recorded in 5, 6 and 11 patients respectively (mean IIEF-5: 19.62). At 12-month follow up, mild erectile dysfunction was found in only one patient (IIEF-5: 20), whereas all other patients were free from erectile dysfunction (mean IIEF-5: 23.75). The 12-month follow up yielded a higher statistical difference (P < 0.001) when compared with 3-month follow up. Study results indicated that appropriate treatment of penile injuries resulted in complete recovery of sexual function within 12 months. ª 2011 Blackwell Verlag GmbH Æ Andrologia 43, 213–216 213