Clinical presentation and surgical outcomes of penile fracture in Tamale Teaching Hospital: a three-year case series

¹Department of Pathology, University for Development Studies, Tamale, Ghana, ²Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana

^&Corresponding author
Benjamin Akinkang, Department of Pathology, University for Development Studies, Tamale, Ghana

Introduction    

Penile fracture is a relatively rare but well-recognized urological emergency characterised by traumatic rupture of the tunica albuginea of the corpora cavernosa, typically occurring when the penis is in an erect state [1]. It is most commonly associated with blunt trauma during sexual intercourse, although other mechanisms such as masturbation, rolling over in bed, or direct trauma have been described [2]. Despite its dramatic presentation and potential for significant morbidity, the true incidence of penile fracture is difficult to ascertain, particularly in low- and middle-income settings, where sociocultural factors, stigma, and underreporting [3] contribute to the limited epidemiological data [4]. Clinically, penile fracture often presents with a characteristic triad of an audible “cracking” or “popping” sound, immediate penile pain, rapid detumescence, and subsequent swelling leading to the classical “eggplant deformity.” [5]. Diagnosis is largely clinical, based on history and physical examination, with imaging modalities such as ultrasonography or magnetic resonance imaging reserved for atypical cases or when associated urethral injury is suspected [5]. Early recognition is crucial, as delayed diagnosis and management are associated with complications, including erectile dysfunction, penile curvature, painful intercourse, and urethral strictures [6].

Management of penile fracture has evolved, with immediate surgical repair now widely regarded as the gold standard of treatment [7]. Surgical exploration allows evacuation of haematoma and repair of the tunical tear, significantly reducing long-term complications compared to conservative approaches [7]. Outcomes following prompt surgical intervention are generally favourable, with high rates of erectile function preservation and minimal morbidity reported across multiple studies [8]. In Ghana, penile fracture remains an uncommon but increasingly reported condition, largely documented through case reports and small case series [9,10,11]. These findings highlight both the consistency of clinical presentation and the challenges related to delayed presentation in the local context. Despite these emerging reports, there remains a paucity of comprehensive data on the presentation patterns, diagnostic approaches, and outcomes of management of penile fracture in Northern Ghana. Variations in health-seeking behaviour, access to specialist urological care, and resource availability may influence both the timing of presentation and treatment outcomes. Consequently, there is a need for more robust local data to better characterise this condition within the Ghanaian setting. This case series, therefore, aims to describe our experience with the presentation, diagnosis, and management of penile fracture in Northern Ghana, with particular emphasis on clinical patterns, treatment modalities, and outcomes. Such data are essential to inform clinical practice, improve early recognition, and optimise management strategies in resource-limited settings.

Methods     

This case series was conducted at the Urology Unit of the Department of Surgery at the Tamale Teaching Hospital, a referral facility for the Northern parts of Ghana. Ethical clearance was waived, and written consent was taken from the patients. We retrospectively reviewed all cases of penile fractures managed in the department from January 2023 to December 2025. Information on age, time between onset and presentation to the health facility, and cause of injury. Other information includes: means of diagnosis (clinical or radiological), physical appearance of the penile shaft, site of injury, urethral involvement, the number of days on admission, and the maintenance of good erection upon review. This information is summarised as patient information and clinical presentation in Table 1. All the 9 patients presented with the history of hearing a popping sound, rapid detumescence, and pain within the penis. Figure 1 is a fractured penis presenting with the characteristic “eggplant” deformity.

Operative techniques: all the patients had surgical intervention. Under spinal anaesthesia, the patients were prepped and draped. Under aseptic technique, a subcoronal degloving incision was made. The fracture sites, which were transverse tears located at the proximal penile shaft, were exposed (Figure 2), as shown in Table 2. For cases with urethral injury as shown in Figure 2, a 16 French urethral catheter was passed, and the urethral ruptures were repaired via simple primary closure with Vicryl 3/0. All the tunica albuginea lacerations were repaired with nylon 3/0. The wounds were closed with Vicryl 0 or Vicryl 2/0. The postoperative condition of the patients was satisfactory, and the patients were discharged from the hospital. Patients with urethral involvement went home with a catheter in situ. The catheters were subsequently removed after 4 weeks post-op. Voiding was satisfactory without lower urinary tract obstruction. All patients were reviewed 3 months after discharge, and all had good erections. No other complications were noted. Data was entered into and analysed using Microsoft Excel. Simple descriptive statistics, such as proportions, mean, and range, were used.

Results     

The hospital saw and managed 9 cases of penile fracture from 2023 to 2025. Three (3) out of the 9 (33.3%) were referred, while the remaining 6 reported directly to the accident and emergency unit in a teaching hospital (TTH). The mean age of presentation was 33.89 (SD, 8.31) with a range of 22 to 47 years. The mean time between injury and presentation to the hospital was 1.72 (SD, 1.66) with a range of 0.5 to 5 hours. Four out of the 9 (44.4%) reported manipulation of the erect penis as the cause of injury, 3 (33.3%) reported coitus as the cause, and the remaining 2 were as a result of falling on an erect penis. All the cases show “eggplant” deformity. Aside from one case that required an ultrasound for diagnosis, the rest were diagnosed clinically. Only one case involved both bilateral corpora cavernosa. Three (33.3%) patients had right corpus cavernosum rupture, 2 had left corpus cavernosum, and 3 also had ventral rupture. The 3 with the ventral rupture also had urethral involvement. The widest dimension of the defects ranged from 1 to 4 cm, with a mean dimension of 2.11 cm (SD, 0.82). All the injuries were located at the proximal penile shaft. The number of days on admission ranges from 2 to 5, with a median of 3 days. There was no postoperative complication. All patients had good erections after 3 months of follow-up review.

Discussion     

Penile fracture is a rare urological emergency that is becoming increasingly common, especially in our jurisdiction. The rarity is due to the mobility of the genital area, making the penis less vulnerable to trauma and subsequent fracture [12]. The true prevalence cannot be accurately ascertained due to underreporting [10]. The reasons for underreporting may be ascribed to patients feeling embarrassed due to the sexually related causes [13]. The fracture involves disruption of the tunica albuginea of the corpus cavernosa [5]. Occasionally, the corpus spongiosum and the urethra may be involved [5]. Penile fracture occurs over a wide age range. A series by Molla et al. involving 18 patients also estimated the mean age at 37, with an age range of 24 to 70 years [14]. The ages of the participants in this series range from 22 to 47, with a mean age of 33.89. In a systematic review of 438 patients by Falcone et al. the mean age was 36 [8], which is not much different from the 33.89 in our study. The causes of penile fracture, among others, include: blunt trauma to the erect penis during sexual intercourse, falling on the erect penis, masturbation, forcefully bending the erect penis, and manipulating the erect penis to achieve detumescence [2]. In our series, the causes in a decreasing frequency include: manipulating the erect penis to achieve detumescence, coitus or sexual intercourse and falling on the erect penis. Sexual intercourse as the cause of injury appears to lead in many of the series [5,11].

When the fracture occurs, the patient will usually hear a cracking or popping sound, followed by rapid detumescence and pain. Swelling will later occur, causing the shaft to deviate to give the characteristic “eggplant” picture [5]. All our 9 cases reported the popping sound, the rapid detumescence, and the pain. In the series by Molla et al. all 18 patients had penile pain and swelling, a penile distortion was present in 15 people (83%), and 13 patients (72%) reported hearing a cracking (popping) sound that causes penile swelling, pain, and fast detumescence [14]. Time is of utmost importance if long term complication from the penile fracture is to be avoided [6]. Many factors, such as socioeconomic factors, financial constraints, embarrassment, etc., may cause a delay in reporting to the hospital [3]. In our series, the mean time duration was 1.72 hours, with some reporting as early as 0.5 hours and others as late as 5 hours. Some authors have reported a time range of 7 hours to 1 month [14] and 3 hours to 10 days [11]. It can be clearly seen that all the cases in this series were reported early to the facility, despite the fact that some were referred from other peripheral facilities.

The diagnosis of all except one case was straightforward based on history and clinical findings. Only one case needed the help of ultrasonography to confirm. This is in line with existing literature [5]. A case series from Cape Coast, Ghana, demonstrated that diagnosis was made clinically in all patients [10]. In their series of 18 patients, Molla et al. used only clinical examination to diagnose 11 patients and an ultrasound scan to confirm the remaining 7 patients [14]. Falcone et al. also revealed in their systematic review that almost all authors employed radiological scans to estimate the extent of penile fracture, but not for diagnosis [8]. This goes to reemphasise the critical role history and physical examination play in the diagnosis of penile fracture, especially in resource-limited settings where access to radiological services may be limited. The fratures are commonly located in the penile shaft and more ventrally [5,14]. Ofori et al. reported 70.6% of their fracture to have occurred in the ventral side [11]. The tunica layers are thinner on the ventral side than the dorsal side, contributing to the high risk of fractures in that area and the vulnerability of the urethra in a fracture [8]. The more ventral urethra is prone to damage [11]. As seen in 3 of these cases, all the ventrally located fractures had associated urethral injury.

The sizes of defects in this series range from 1 to 4 cm, with a mean size of 2.11 cm in the widest dimension. This is not so different from the findings of Ofori et al. who reported 0.5 to 3 cm [11]. Molla et al. also reported similar sizes [14]. The distribution of our fracture sites is in line with the literature [5,8]. In this case series, 33.3% of the fractures occurred at the right corpus cavernosum, and 33.3% at the ventral side, which is in line with Ofori et al. [11]. Immediate surgical intervention is required to achieve good results and to reduce hospital stay [15]. While most recent authors advocate for immediate surgical repair for fractures with or without urethral involvement [5,7], conservative management can sometimes be employed if there is delayed presentation or in special cases [14]. Early surgical intervention is noted to be associated with fewer complications compared to conservative management [5]. It also results in better outcomes in terms of reduced penile curvature, erectile dysfunction, etc. [5]. Ofori et al. performed immediate surgery for 70.6% of their 17 cases [11]. Molla et al. performed surgery for 77.7% of their 18 cases, with only 4 managed conservatively due to a delay of more than a week before presentation [14]. All 9 cases in this series had immediate surgery with subsequent good outcomes.

A circumferential incision was made just beneath the corona, and the skin was degloved to expose the injury sites. This kind of approach, which is the most common approach, gives the surgeon a better vision, helping locate the injury site [8]. The choice of suture type to close the tunica defect depends on the surgeon and the type available. Proponents of employing non-absorbable sutures to close tunical defects contend that they give the tunical edges long-lasting support, assisting in maintaining their alignment and preventing the defect's breakdown or recurrence during times of elevated intracorporeal pressure [7]. In this case series, the urethral injuries were sutured using Vicryl in an interrupted manner. The corpus cavernosa and tunica were closed using nylon, also in an interrupted fashion. Postoperative review after 3 months showed full recovery, restoration of good erection and no other complications. Ofori et al. reported 17.6% of their patient had wound infection, 23.3% hard short-term complications such as penile curvature and painful sex, and 41. 2% had erectile dysfunction [11]. Even though the huge sample size of Ofori et al. series may account for this, the increased mean duration of injury before reporting may have also contributed to these complications [6,11].

Limitation: this study has several limitations. The small sample size and single-centre design limit the generalisability of the findings to the broader population. The relatively short follow-up period of 3 months may not adequately assess long-term complications such as erectile dysfunction, penile curvature, or urethral stricture. Additionally, the absence of a comparison group precludes evaluation of outcomes between different management approaches.

Conclusion     

Penile fracture, though uncommon, is a true urological emergency with a characteristic clinical presentation that allows for prompt diagnosis even in resource-limited settings. This case series from Northern Ghana demonstrates that most patients present early and can be accurately diagnosed based on history and physical examination without reliance on advanced imaging. Immediate surgical exploration and repair using a subcoronal degloving approach resulted in excellent outcomes, including preservation of erectile function and absence of postoperative complications at short-term follow-up. Our findings reinforce the growing body of evidence that early surgical intervention is the gold standard for the management of penile fracture, including cases with associated urethral injury. The uniformly favourable outcomes observed in this series highlight the importance of timely presentation and access to surgical care. Given the potential for underreporting due to sociocultural stigma, there is a need for increased public awareness to encourage early health-seeking behaviour. Additionally, strengthening urological services and surgical capacity in peripheral centres may further improve outcomes. Larger, multicentre studies with longer follow-up are recommended to better characterise long-term complications and functional outcomes in this setting.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

All authors were involved in the conceptualisation, analysis, and writing up of this work. All the authors have read and approved the final version of this manuscript.

Tables and figures     

Table 1: information and clinical presentation of patients managed for penile fracture in TTH from January 2023 to December, 2025

Table 2: operative and postoperative findings of patients managed for penile fracture in TTH from January 2023 to December, 2025

Figure 1: fractured penis with “eggplant” deformity of one of the patients managed for penile fracture in TTH from January 2023 to December, 2025

Figure 2: defects in the tunica and corpus cavernosum in the proximal penile shaft of two of the patients managed for penile fracture in TTH from January 2023 to December, 2025

References