Long-term erectile function outcomes following penile fracture repair: The critical impact of surgical timing on three-year outcomes

Aim: Penile fracture is a urological emergency requiring urgent surgical intervention. While early repair within the first 24-48 hours is considered the gold standard, the impact of surgical timing is not established and long-term outcomes regarding erectile function are poorly understood due to relatively short follow-up and inconsistent use of validated assessment tools. We aimed to evaluate long-term erectile function outcomes after penile fracture surgery and to determine clinical factors associated with erectile dysfunction.

Materials and Methods: This retrospective cohort study included 38 patients who underwent surgery for penile fracture between January 2014 and December 2023. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire before surgery, at 6 months, and 1, 2, and 3 years after surgery.

Results: The mean follow-up period was 66.17±40.22 months. The preoperative IIEF-5 score was 22.50±1.99, which decreased to 17.63±3.40 at 6 months and remained at 19.58±2.64 at 3 years, showing a persistent decrease (p=0.001). The fracture-to-surgery time interval was negatively correlated with the change in IIEF-5 score. Postoperative angulation was observed in 21.1% of patients and was significantly associated with mid-shaft fractures (p=0.023). Nodule formation was observed in 21.1% of cases and showed a strong relationship with delayed surgery (median 42 hours vs. 8 hours, p=0.001).

Conclusion: Delay in surgery is the most important modifiable risk factor and longer delays have progressively adverse effects. These findings indicate that urgent surgical intervention is critical in penile fracture.