Login to Access Video or Poster Abstract: MP79-14
Sources of Funding: None

Introduction

Penile fracture (PFx) is a rare form of genital trauma (GT) that can impact long term penile health and sexual quality of life. Population data describing real world incidence and management of PFx are scarce. We describe the management of PFx in relation to American Urological Association (AUA) urotrauma guidelines using a large statewide database.

Methods

We queried the New York Statewide Planning and Research Cooperative System database for men presenting to an Emergency Room with PFx from 2003-2014. Patients were identified with ICD-9-CM diagnosis 95913. Management was defined as surgical or nonsurgical by concomitant procedural codes for any penile or urethral surgery. Use of diagnostic tests for urethral evaluation was determined by CPT codes. Guideline compliance was defined as surgical management or non-surgical management only if imaging was performed. Incidence was calculated from New York census data. Patients were tracked for PFx sequelae.

Results

711 men presented with PFx with mean age 38 years (Range 18-81). PFx accounted for 6.2% of all GT over this time. The incidence rate was 0.83 cases/100,000 person-years (p-y) with a peak in men 30-39 years old (1.31 cases/100,000 p-y). Eighty men (11.3%) underwent urethral evaluation, 15 (2.1%) had diagnostic ultrasound and 397 (55.8%) underwent surgery (Figure 1). All men with ultrasound were managed conservatively. The AUA guideline compliance rate was 58%. On multivariate logistic regression, high comorbidity burden was associated with low compliance (OR [95% CI]: 0.35 [0.16-0.73], p<0.01) whereas non-White race (1.58 [1.16-2.16], p<0.01) and academic centers (1.53 [1.11-2.11], p=0.01) were associated with high compliance. PFx sequelae (erectile dysfunction, urethral stricture, Peyronie&[prime]s disease) developed in 12 patients (1.7%).

Conclusions

This is the largest report of PFx incidence and management in the literature to date. PFx is rare with peak rate in men 30-39 years old. About half of cases were managed surgically with overall guideline compliance rate of only 58%. This may reflect suboptimal management or incorrect diagnostic coding of non-fracture injuries. Efforts to improve physician education on the management of suspected PFx is crucial given its potential for long term morbidity.

Funding

None