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The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy

  • Men's Health (R Carrion, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the current literature on acute management of traumatic penile fracture, with a specific discussion of those injuries following collagenase clostridium histolyticum (CCH) injections for the treatment of Peyronie’s disease.

Recent Findings

The immediate repair of traumatic penile fracture injury is associated with significantly better prognosis for long-term sexual health. Corporal disruption following CCH administration has several distinct features, and the trend is to manage these patients conservatively in the absence of urethral injury.

Summary

Traumatic penile fracture repair continues to have excellent results when performed immediately following injury. The post-CCH treatment setting portends increased difficulty during surgical management and can be successfully managed in most cases by conservative measures.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barros R, Hampl D, Cavalcanti AG, Favorito LA, Koifman L. Lessons learned after 20 years' experience with penile fracture. Int Braz J Urol. 2020;46(3):409–16.

    Article  Google Scholar 

  2. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: an 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med. 2009;6(4):1141–50.

    Article  Google Scholar 

  3. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current management of penile fracture: an up-to-date systematic review. Sex Med Rev. 2018;6(2):253–60.

    Article  Google Scholar 

  4. Fernstrom U. Rupture of the penis. Report of one operated case and review of literature. Acta Chir Scand. 1957;113(3):211–7.

    CAS  PubMed  Google Scholar 

  5. Dias-Filho AC, Fregonesi A, Martinez CAT, Pimentel ES, Riccetto CLZ. Can the snapping sound discriminate true from false penile fractures? Bayesian analysis of a case series of consecutively treated penile fracture patients. Int J Impot Res. 2020;32(4):446–454

  6. Izzo L, Izzo S, Pugliese F, Izzo P, Messineo D, Selvaggi F, et al. The role of imaging in penile fracture our experience. Ann Ital Chir. 2019;90:330–4.

    PubMed  Google Scholar 

  7. Cozzi D, Verrone GB, Agostini S, Bartolini M, D’Amico G, Pradella S, et al. Acute penile trauma: imaging features in the emergency setting. Radiol Med. 2019;124(12):1270–80.

    Article  Google Scholar 

  8. Panayiotou A, Huang DY, Makanjuola JK, Sidhu PS. Penile fracture: added value of novel assessment with contrast-enhanced ultrasound. BMJ Case Rep. 2019;12(7):e230864

  9. Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–35. https://doi.org/10.1016/j.juro.2014.05.004.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sokolakis I, Schubert T, Oelschlaeger M, Krebs M, Gschwend JE, Holzapfel K, et al. The role of magnetic resonance imaging in the diagnosis of penile fracture in real-life emergency settings: comparative analysis with intraoperative findings. J Urol. 2019;202(3):552–7.

    Article  Google Scholar 

  11. Bhoopathy SV, Kim LH. The value of pre-operative MRI in management of penile fractures. Urol Case Rep. 2020;31:101185. Published 2020 Apr 6. https://doi.org/10.1016/j.eucr.2020.101185.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zare Mehrjardi M, Darabi M, Bagheri SM, Kamali K, Bijan B. The role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair. Int Urol Nephrol. 2017;49(6):937–45.

    Article  Google Scholar 

  13. Lindquist CM, Nikolaidis P, Mittal PK, Miller FH. MRI of the penis. Abdom Radiol (NY). 2020;45(7):2001–2017

  14. Barros R, Ribeiro JGA, da Silva HAM, de Sá FR, Fosse AM Jr, Favorito LA. Urethral injury in penile fracture: a narrative review. Int Braz J Urol. 2020;46(2):152–7. https://doi.org/10.1590/S1677-5538.IBJU.2020.99.02.

    Article  PubMed  PubMed Central  Google Scholar 

  15. De Luca F, Garaffa G, Falcone M, et al. Functional outcomes following immediate repair of penile fracture: a tertiary referral centre experience with 76 consecutive patients. Scand J Urol. 2017;51(2):170–5.

    Article  Google Scholar 

  16. Kamdar C, Mooppan UM, Kim H, Gulmi FA. Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome. BJU Int. 2008;102(11):1640–4 discussion 1644.

    Article  Google Scholar 

  17. Mydlo JH, Hayyeri M, Macchia RJ. Urethrography and cavernosography imaging in a small series of penile fractures: a comparison with surgical findings. Urology. 1998;51(4):616–9.

    Article  CAS  Google Scholar 

  18. EAU Guidelines. Edn. presented at the EAU Annual Congress, Amsterdam, the Netherlands, 2020. ISBN 978-94-92671-07-3.

  19. Rosenstein D, McAninch JW. Urologic emergencies. Med Clin North Am. 2004;88(2):495–518.

    Article  Google Scholar 

  20. Creecy AA, Beazlie FS Jr. Fracture of the penis: traumatic rupture of corpora cavernosa. J Urol. 1957;78:620–7.

    Article  CAS  Google Scholar 

  21. Özorak A, Hoşcan MB, Oksay T, Güzel A, Koşar A. Management and outcomes of penile fracture: 10 years' experience from a tertiary care center. Int Urol Nephrol. 2014;46(3):519–22. https://doi.org/10.1007/s11255-013-0531-y.

    Article  PubMed  Google Scholar 

  22. Yamaçake KG, Tavares A, Padovani GP, Guglielmetti GB, Cury J, Srougi M. Long-term treatment outcomes between surgical correction and conservative management for penile fracture: retrospective analysis. Korean J Urol. 2013;54(7):472–6. https://doi.org/10.4111/kju.2013.54.7.472.

    Article  PubMed  PubMed Central  Google Scholar 

  23. • Amer T, Wilson R, Chlosta P, et al. Penile fracture: a meta-analysis. Urol Int. 2016;96(3):315–29 Meta-analysis of outcomes in series of traumatic penile fracture patients.

    Article  Google Scholar 

  24. Al Ansari A, Talib RA, Shamsodini A, Hayati A, Canguven O, Al NA. Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review. Int J Impot Res. 2013;25(6):221–3.

    Article  Google Scholar 

  25. Kozacıoğlu Z, Ceylan Y, Aydoğdu Ö, Bolat D, Günlüsoy B, Minareci S. An update of penile fractures: long-term significance of the number of hours elapsed till surgical repair on long-term outcomes. Turk J Urol. 2017;43(1):25–9.

    Article  Google Scholar 

  26. Bozzini G, Albersen M, Otero JR, Margreiter M, Cruz EG, Mueller A, et al. Delaying surgical treatment of penile fracture results in poor functional outcomes: results from a large retrospective multicenter European study. Eur Urol Focus. 2018;4(1):106–10. https://doi.org/10.1016/j.euf.2016.02.012.

    Article  PubMed  Google Scholar 

  27. Kozacioglu Z, Degirmenci T, Arslan M, Yuksel MB, Gunlusoy B, Minareci S. Long-term significance of the number of hours until surgical repair of penile fractures. Urol Int. 2011;87(1):75–9. https://doi.org/10.1159/000325589.

    Article  PubMed  Google Scholar 

  28. Phillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. Andrology. 2015;3(3):632–6. https://doi.org/10.1111/andr.12043.

    Article  PubMed  Google Scholar 

  29. El-Assmy A, El-Tholoth HS, Abou-El-Ghar ME, Mohsen T, Ibrahiem EH. Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture. Int J Impot Res. 2012;24(1):20–5. https://doi.org/10.1038/ijir.2011.41.

    Article  CAS  PubMed  Google Scholar 

  30. Raheem AA, El-Tatawy H, Eissa A, Elbahnasy AH, Elbendary M. Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption. Arch Ital Urol Androl. 2014;86(1):15–9.

    Article  Google Scholar 

  31. Acimovic M, Zivkovic M, Georgescu AV, Matei IR, Bumbasirevic U. Repair of urethral injury associated with penile fracture using buccal mucosa graft: a novel therapeutic approach for complex cases. Injury. 2020;s0020-1383(20)30190-X

  32. •• Gelbard M, Goldstein I, Hellstrom WJ, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of Peyronie’s disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013;190(1):199–207 Initial study of CCH treatment leading to FDA approval.

    Article  CAS  Google Scholar 

  33. Hellstrom WJG, Tue Nguyen HM, Alzweri L, Chung A, Virasoro R, Tapscott A, et al. Intralesional collagenase Clostridium histolyticum causes meaningful improvement in men with Peyronie’s disease: results of a multi-institutional analysis. J Urol. 2019;201(4):777–82. https://doi.org/10.1097/JU.0000000000000032.

    Article  PubMed  Google Scholar 

  34. •• Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional injection of collagenase clostridium histolyticum may increase the risk of late-onset penile fracture. Sex Med Rev. 2018;6(2):272–8 Contributed to new recommendations for prolonged abstinence from sexual activity following CCH therapy.

    Article  Google Scholar 

  35. Abdel Raheem A, Capece M, Kalejaiye O, Abdel-Raheem T, Falcone M, Johnson M, et al. Safety and effectiveness of collagenase clostridium histolyticum in the treatment of Peyronie’s disease using a new modified shortened protocol. BJU Int. 2017;120(5):717–23. https://doi.org/10.1111/bju.13932.

    Article  CAS  PubMed  Google Scholar 

  36. Capece M, Cocci A, Russo G, Cito G, Giubilei G, Cacciamani G, et al. Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study. Andrology. 2018;6(4):564–7. https://doi.org/10.1111/andr.12497.

    Article  CAS  PubMed  Google Scholar 

  37. ] Yafi FA, Diao L, DeLay KJ, et al. Multi-institutional prospective analysis of intralesional injection of collagenase clostridium histolyticum, tunical plication, and partial plaque excision and grafting for the management of Peyronie’s disease. Urology. 2018;120:138–42. https://doi.org/10.1016/j.urology.2018.06.049Highlights feasibility and risk of surgery for correction of peyronie’s disease following CCH therapy.

    Article  PubMed  Google Scholar 

  38. Ziegelmann MJ, Viers BR, Montgomery BD, Avant RA, Savage JB, Trost LW. Clinical experience with penile traction therapy among men undergoing collagenase clostridium histolyticum for Peyronie’s disease. Urology. 2017;104:102–9. https://doi.org/10.1016/j.urology.2017.01.054.

    Article  PubMed  Google Scholar 

  39. Yang KK, Bennett N. Peyronie's disease and injectable collagenase clostridium histolyticum: safety, efficacy, and improvements in subjective symptoms. Urology. 2016;94:143–7. https://doi.org/10.1016/j.urology.2016.04.049.

    Article  PubMed  Google Scholar 

  40. Levine LA, Cuzin B, Mark S, Gelbard MK, Jones NA, Liu G, et al. Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie’s disease: a phase 3 open-label study. J Sex Med. 2015;12(1):248–58. https://doi.org/10.1111/jsm.12731.

    Article  PubMed  Google Scholar 

  41. Yafi FA, Anaissie J, Zurawin J, Sikka SC, Hellstrom WJ. Results of SMSNA survey regarding complications following intralesional injection therapy with collagenase clostridium histolyticum for Peyronie’s disease. J Sex Med. 2016;13(4):684–9.

    Article  Google Scholar 

  42. Gelbard M, Lipshultz LI, Tursi J, Smith T, Kaufman G, Levine LA. Phase 2b study of the clinical efficacy and safety of collagenase clostridium histolyticum in patients with Peyronie’s disease. J Urol. 2012;187(6):2268–74.

    Article  CAS  Google Scholar 

  43. •• Kominsky H, Beebe S, Shah N, Jenkins LC. Surgical reconstruction for penile fracture: a systematic review. Int J Impot Res. 2020;32(1):75–80. https://doi.org/10.1038/s41443-019-0212-1Thorough review of surgical management of penile fracture.

    Article  PubMed  Google Scholar 

  44. Beilan JA, Baumgarten AS, Bickell M, Parker J, Carrion RE. Suspected penile fracture after Xiaflex injection and use of a VED. Urology. 2016;98:4–7. https://doi.org/10.1016/j.urology.2016.07.026.

    Article  PubMed  Google Scholar 

  45. Metzler IS, Reed-Maldonado AB, Lue TF. Suspected penile fracture: to operate or not to operate? Transl Androl Urol. 2017;6(5):981–6. https://doi.org/10.21037/tau.2017.07.25.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Greear GM, Koprowski CJ, Hsieh TC. Managing complications of collagenase clostridium histolyticum (CCH) injection. World J Urol. 2020;38(2):287–92. https://doi.org/10.1007/s00345-019-02817-4.

    Article  PubMed  Google Scholar 

  47. Natale C, McLellan DM, Yousif A, Hellstrom WJG. Review of intralesional collagenase clostridium histolyticum injection therapy and related combination therapies in the treatment of Peyronie's disease (an update) [published online ahead of print, 2020 Mar 18]. Sex Med Rev. 2020;S2050–0521(20):30009–3. https://doi.org/10.1016/j.sxmr.2020.01.005.

    Article  Google Scholar 

  48. DeLay K, Diao L, Nguyen HMT, Zurawin J, Libby R, Yafi F, et al. Successful treatment of residual curvature in Peyronie disease in men previously treated with Intralesional collagenase Clostridium Histolyticum. Urology. 2017;110:110–3. https://doi.org/10.1016/j.urology.2017.08.037.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave, 8642, New Orleans, LA, 70112, USA

    William M. Hughes, Caleb Natale & Wayne J. G. Hellstrom

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  1. William M. Hughes
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  2. Caleb Natale
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Correspondence to Wayne J. G. Hellstrom.

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Wayne Hellstrom is on a speaker’s bureau for Endo Pharmaceuticals and was also a principle investigator for the IMPRESS trials. William Hughes and Caleb Natale each declare that they have no potential conflicts of interest.

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Hughes, W.M., Natale, C. & Hellstrom, W.J.G. The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy. Curr Urol Rep 22, 13 (2021). https://doi.org/10.1007/s11934-020-01025-7

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