Penile Fracture
Penile fracture is rupture of the tunica albuginea of an erect penis — a clinical diagnosis (crack, pain, immediate detumescence, swelling) that needs prompt surgical repair, with assessment for urethral injury.
The big picture
During erection the tunica albuginea is thin and taut. A sudden bending force (often during intercourse) ruptures it, sometimes with injury to the corpus spongiosum/urethra. The patient reports a cracking/popping sound, immediate pain, rapid loss of erection (detumescence), and swelling/bruising — the 'aubergine/eggplant' deformity from a haematoma contained by Buck's fascia.
Classic penile fracture = prompt surgical repair; always check for a urethral injury before/at surgery. Do not manage it conservatively.
Red flags
Worse outcomes — a true penile fracture needs prompt surgical repair.
Concomitant urethral injury — RUG and repair the urethra.
Suspect urethral involvement before catheterising.
Mechanism pathway
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Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Prompt surgical exploration and repair of the tunical (and any urethral) defect to preserve function and prevent deformity.
Complications
- Haematoma
- Urethral injury
- Penile deformity
- Erectile dysfunction, curvature, painful nodules (less likely with prompt repair)
- Early surgical repair
- Identify and repair urethral injury
- Treat ED/curvature; manage strictures
If treatment fails
If curvature or erectile dysfunction develops, ask: is this from delayed repair, an inadequate closure, or an unrecognised urethral injury?
Memory hooks
Crack + pain + detumescence + eggplant = penile fracture.
It's a clinical diagnosis.
Operate promptly — don't sit on it.
Always check the urethra.
Board traps
Classic penile fracture → surgical repair, NOT conservative management.
Forgetting to assess for urethral injury.
Catheterising blindly when a urethral injury is suspected.
Clinical cases
During intercourse a man hears a crack, feels sudden pain, loses his erection immediately, and develops marked penile swelling and bruising. There is no blood at the meatus and he can void.
What is the diagnosis and the correct management?