Acute penile fracture, Peyronie's disease, and indications for circumcision

What is an acute penile fracture?

In urology and andrology emergencies, acute penile fracture is one of the most embarrassing conditions for patients. When the penis is not erect, it is a soft organ and cannot be broken; however, if the penis is subjected to acute external force while erect, penile fracture can occur.

The key to penile erection lies in the structure of the corpora cavernosa within the penis. When the penis is erect, a large amount of blood flows into the corpora cavernosa, much like a small balloon being inflated. If, under these conditions, external force causes the corpora cavernosa to rupture, penile fracture can occur. The most common cause of penile fracture is an accidental, forceful injury during sexual intercourse.

When the penis fractures, in addition to experiencing sudden, severe pain, the person may also hear a crisp popping sound, like a balloon bursting. Following this, the penis will develop bruising, which can quickly progress into severe swelling and bruising, causing the entire penis to become swollen and enlarged. This is actually internal bleeding caused by the leakage of blood from the corpora cavernosa after the corpora cavernosa ruptures.

Treatment of acute penile fracture

The most appropriate course of action is to seek treatment at a reputable hospital as soon as possible. Surgical repair of the ruptured corpora cavernosa will immediately reduce swelling and prevent future sexual dysfunction. Additionally, some patients with penile fractures may also experience urethral injury, resulting in urethral bleeding, which also needs to be addressed during penile fracture treatment.

While penile fractures are uncommon, the panic and uncertainty experienced by those involved can delay seeking medical attention, potentially impacting future erectile function. These incidents often occur when attempting unusual sexual positions, causing penile twisting or sudden impact that leads to breakage. Some statistics suggest that the woman-on-top position during intercourse increases the risk of penile fracture; therefore, with increasingly open attitudes towards sex, this acute condition may become more prevalent.

What is Peyronie's disease?

Peyronie's disease, also known as penile fibrosis or cavernositis, is characterized by inflammatory fibrosis and induration of the corpora cavernosa and tunica albuginea of ​​the penis. The exact cause remains unclear, but it is generally believed to be related to injury, infection, immunity, and vitamin E deficiency. Recent reports suggest a possible link to certain genetic factors. The lesions occur within the tunica albuginea or corpora cavernosa of the penis. Initially, lymphocytes and plasma cells infiltrate around small blood vessels in the connective tissue, rapidly progressing to fibrosis and plaque formation. Later, the disease progression slows, and although localized calcification or ossification may occasionally occur, there is no tendency for malignant transformation.

How to treat Peyronie's disease

Currently, there is a lack of specific treatments, and a comprehensive treatment approach is generally recommended. Non-surgical treatment is suitable for early-stage, milder lesions, and in a few cases, the lesions may spontaneously remit or stop progressing. It has been reported that oral administration of a large dose of vitamin E (100mg) three times daily for three months can alleviate or eliminate symptoms in approximately 20% of early-stage patients. Physical therapy, often using audio-visual ablation devices, has some effect on earlier lesions, dilating capillaries within the fibrous mass, increasing blood flow, and promoting the recovery of nerve and vascular function. In some cases, the induration shrinks, and painful erections improve or disappear. Local superficial X-ray irradiation has analgesic and induration-releasing effects, showing some efficacy in a few cases, but it cannot cure the condition. Other methods include traditional Chinese medicine treatment based on syndrome differentiation, such as Xuefu Zhuyu Decoction, or, depending on the circumstances, external washing with Chinese herbal decoctions, massage, medium-wave or microwave penetration, and magnetic therapy, which can also achieve some therapeutic effect, but the induration is difficult to eliminate completely.

There is currently no consensus on the surgical removal of lesions. For patients with obvious symptoms and localized, single lesions with induration, surgical resection combined with skin grafting to the defect area may be considered. Strict hemostasis should be maintained during the operation to prevent postoperative worsening of the condition. For patients with erectile dysfunction, negative pressure suction sexual function rehabilitation therapy machines can be used; some also suggest that penile prosthesis implantation should be performed simultaneously with surgical resection of the induration.

What foreskin condition requires surgery?

(1) Phimosis: The front end of the foreskin is almost completely closed, leaving only a round hole. When urinating, the front end of the foreskin swells like a blister, and then the urine is discharged from the round hole.

As the penis grows and thickens during puberty, the foreskin retracts towards its base. Although the skin has a high degree of elasticity, phimosis still restricts penile development to some extent. Furthermore, because the external opening of the foreskin is narrow, smegma cannot be discharged promptly, easily forming flat, round smegma stones around the glans. Therefore, surgical treatment is best performed before puberty.

(2) The foreskin is tight at the front. Although it can be retracted, only the urethral opening or a small part of the glans can be seen. When the penis is erect, the glans is not exposed or only partially exposed. The tight foreskin opening makes men feel uncomfortable and even painful, which hinders the pleasant mood during intercourse.

In a few cases, after the foreskin is retracted, a scarf-like circle of edema forms tightly around the coronal sulcus, a condition known as paraphimosis, which causes more pronounced and severe pain.

(3) Excessive foreskin leads to recurrent balanitis, causing the originally soft and flexible foreskin opening to thicken and harden, resulting in pain and bleeding when retracting the foreskin, making it impossible to retract the foreskin.

The above-mentioned foreskin condition should be treated surgically as soon as possible.