Penile Fracture Management at Trauma Centers in the United States.

Introduction: Current AUA urological trauma guidelines recommend prompt surgical intervention for patients presenting with acute penile fracture to minimize potential risks of erectile dysfunction and penile curvature. Given its relatively rare occurrence, there have been few large population-based studies evaluating real-world management of penile fracture. We hypothesized that there is variability in intervention for patients presenting with penile fracture associated with patients' clinical and demographic characteristics and hospital characteristics.

Methods: The Trauma Quality Improvement Program database from 2007 to 2017 was analyzed, and patients with diagnosis codes for penile fracture were identified. Patient demographic data and hospital characteristics were analyzed. Multivariable analysis was performed to identify patient and hospital characteristics associated with surgical intervention for penile fracture.

Results: We identified 940 patients presenting with penile fracture. The median age was 39 (IQR: 31-47) years. Of the 940 patients, 658 (70%) of patients underwent surgery for penile fracture during the index admission. On multivariable regression analysis, hospital teaching status, type of insurance, and absence of urethral injury diagnosis were significantly associated with the likelihood of intervention.

Conclusions: In this large retrospective study, most patients underwent immediate penile fracture repair. However, several patients did not have surgery at the time of their presentation, which was associated with presenting to a nonteaching hospital, having government health insurance, and the presence of urethral injury. Advocating for prompt surgical management remains paramount for improving care for patients with penile fracture.