IJIR: Your Sexual Medicine Journal https://doi.org/10.1038/s41443-019-0159-2 ARTICLE Older age and a large tunical tear may be predictors of increased erectile dysfunction rates following penile fracture surgery Mazhar Ortac 1 ● Faruk Özgor 1 ● Ufuk Caglar 1 ● Abdullah Esmeray 1 ● Metin Savun 1 ● Ömer Sarılar 1 Received: 21 December 2018 / Revised: 14 January 2019 / Accepted: 20 April 2019 © The Author(s), under exclusive licence to Springer Nature Limited 2019 Abstract Penile fracture is a rare urological occurrence resulting from a tear in the tunica albuginea of the penis. In this study, 26 patients diagnosed with a penile fracture were treated with early surgical correction. The mean age at the time of the injury was 41.7 years. The average follow-up time of the study population was 28.8 months. The mean time from fracture to surgery was 15.6 ± 19.9 h. In total, 23% of the patients had a penile nodule and 11.5% of these patients reported penile deviation. Post surgery, erectile dysfunction (ED) was present in nine (34.6%) patients. During the follow-up, the mean International Index of Erectile Function (IIEF-5) score was 20.9 ± 4.3 (10–25). There was no significant difference in the time from fracture to surgery among the patients with or without ED. However, the tunical tear size was significantly larger in the patients with ED as compared with those without ED. Furthermore, the patients with ED were older than those without ED. Older age and the size of the tunical tear appeared to be correlated with the development of ED. However, prospective large series are needed to confirm these results. Introduction Penile fracture is a rare urological occurrence resulting from a tear in the tunica albuginea of the penis [1]. The incidence and etiology of penile fractures differ, depending on the geographical area [2]. In the Middle East, the most frequent cause is reported to be forceful manipulation (taqaandan or the taqaandan maneuver) of the penis, whereas penile fractures more commonly occur during sexual intercourse in Western Europe [1, 3]. Other etiologies of penile fractures include rolling over in bed while the penis is erect, external trauma, and forceful bending of the penis during masturbation [4]. The site of tunical rupture varies but is mostly single sided or at the base or midshaft of the penis [5]. In addition, the type of sexual position may affect the severity of the penile fracture. Recently, a study showed that the “man-on-top” and “doggy style” positions were associated with bilateral fractures and urethral injury [6]. Fracture of the penis is generally diagnosed via a medical history and physical examination. The most common pre- sentations are a penile hematoma and rapid detumescence, penile pain, swelling, cracking sounds, and penile deviation. Penile fracture may be associated with urethral injury in cases of severe trauma. Patients with urethral injuries mostly complain of urethrorrhagia [5, 7, 8]. Other than a medical history and physical examination, a few authors have suggested that radiological imaging, such as ultrasonography (USG), should be performed for patients with an unusual presentation to detect the location of the tunical tear and possible associated urethral injury [9]. However, others indicated that routine urethrography was not recommended for these patients [7, 10]. Currently, there is no evidence-based algorithm for the management of a penile fracture. However, numerous published studies have reported that surgical correction is beneficial in terms of functional and anatomical outcomes, as compared with those achieved by conservative treatment options [11–13]. Penile exploration and tunical repair can be performed with a subcoronal incision and degloving of the penis or local incision directly above the site of injury [14]. Recently, the popularity of early surgical repair rather than delayed surgery has increased, due to good functional results and low rates of late complications, as compared with the outcomes of delayed surgery [15]. Despite the immediate * Mazhar Ortac m_ortac@hotmail.com 1 Haseki Training and Research Hospital, Department of Urology, Istanbul, Turkey 1234567890();,: 1234567890();,: