Suspected Penile Fracture
Acute penile injury with classic presentation
All Pathways
UrologyEmergency
Penile Fracture Management (AUA Urotrauma 2020)
Penile Fracture Management (AUA Urotrauma 2020): Suspected Penile Fracture → Classic History & Exam → Signs of Urethral Injury? → Urethral Evaluation → ...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Classic History & Exam
Diagnosis is primarily clinical
- Popping/cracking sound during erection
- Immediate detumescence
- Rapid swelling and ecchymosis
- 'Eggplant deformity' - swollen, purple penis
- Penile deviation away from injury
- Usually during intercourse or masturbation
03Decision Signs of Urethral Injury?
Blood at meatus, gross hematuria, inability to void
04Action Urethral Evaluation
10-22% have concomitant urethral injury
- Retrograde urethrogram (RUG) OR
- Flexible cystoscopy
- Document injury location and extent
- Plan repair at time of tunical repair
- Place suprapubic catheter if complete disruption
05Action Prepare for Surgery
Prompt surgical exploration and repair
- NPO, IV access
- Consent for exploration and repair
- Discuss potential outcomes
- Urology consult if not already
- Target: Surgery within 24 hours
06Warning ⚠️ Early Repair Critical
Delay increases complication risk
- Surgery <24h: 7.6% complication rate
- Surgery >24h: 68.7% complication rate
- 96% good outcomes with surgical repair
- 50% good outcomes with conservative treatment
- ED risk increases with delayed repair
07Action Surgical Exploration & Repair
Definitive management
- Degloving incision (circumcision or ventral)
- Evacuate hematoma
- Identify tunical defect(s)
- Primary repair with absorbable suture (3-0 or 4-0)
- Interrupted or running closure
- Repair urethral injury if present
- Close in layers
08Action Post-Operative Care
Recovery and monitoring
- Foley catheter for 24-48 hours
- Compression dressing
- Ice to reduce swelling
- NSAIDs for pain (avoid if urethral repair)
- Abstain from sexual activity 4-6 weeks
- Urology follow-up in 2-4 weeks
09Action Patient Counseling
Discuss expected outcomes
- Most patients resume normal erectile function
- Risk of erectile dysfunction 1-10%
- Risk of penile curvature (Peyronie's) 1-10%
- Risk of painful erection
- May need long-term follow-up if issues arise
10Outcome Good Outcome Expected
With prompt repair, 96% satisfactory results
11Outcome Monitor for Complications
ED, curvature, chronic pain possible
12Decision Diagnosis Clear?
Classic history and physical examination
- Path rejoins step 05Shared downstream outcome
13Action Consider Imaging (If Equivocal)
Not routinely needed if diagnosis clear
- Ultrasound: Most common, readily available
- MRI: Higher sensitivity if US equivocal
- Look for tunical defect
- Do NOT delay surgery for imaging
- If imaging equivocal but clinical suspicion high → explore
- Path rejoins step 05Shared downstream outcome
Guideline Source
AUA Urotrauma Guideline 2020 (Amended 2022)
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address delayed presentations in detail
- Does not cover pediatric penile trauma
- Imaging modality selection may vary by institution
- Long-term ED outcomes depend on injury severity
- Does not address penetrating penile trauma
Contraindicated Populations
pediatric
Applicable Regions
USEUUKAU
AU: Follow AUA/EAU guidance
EU: EAU Urological Trauma guidelines similar approach
UK: BAUS recommends repair within 24 hours
US: AUA Urotrauma 2020 guideline - prompt surgical repair
Version 1Next review: 2028-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the Penile Fracture Management (AUA Urotrauma 2020)?
The Penile Fracture Management (AUA Urotrauma 2020) is a emergency clinical algorithm for Urology. It provides a structured decision tree to guide clinical decision-making, based on AUA Urotrauma Guideline 2020 (Amended 2022).
What guideline is the Penile Fracture Management (AUA Urotrauma 2020) based on?
This algorithm is based on AUA Urotrauma Guideline 2020 (Amended 2022) (DOI: 10.1097/JU.0000000000001408).
What are the limitations of the Penile Fracture Management (AUA Urotrauma 2020)?
Known limitations include: Does not address delayed presentations in detail; Does not cover pediatric penile trauma; Imaging modality selection may vary by institution; Long-term ED outcomes depend on injury severity; Does not address penetrating penile trauma. Individual patient factors may require deviation from these recommendations.
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