Reviews - Andrology
Vol. 97 No. 3 (2025)
https://doi.org/10.4081/aiua.2025.14195
What are the risk factors for erectile dysfunction following penile fracture surgery? A systematic review and meta-analysis
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 28 July 2025
Accepted: 28 August 2025
Published: 30 September 2025
Accepted: 28 August 2025
Published: 30 September 2025
412
Views
343
Downloads
Background: Penile fracture is one of the rare urological emergencies resulting in rupture of the tunica albuginea in the penile corpora cavernosa. Sexual intercourse is known to be the most common aetiology of penile fracture, which usually happens during erection. Immediate surgical intervention is crucial to avoid any complications. Erectile dysfunction is the most feared complication after surgery. This meta-analysis aimed to analyse and determine risk factors of erectile dysfunction among patients who underwent penile fracture surgery.
Methods: Literature searching was conducted in several databases, e.g., Pubmed, Cochrane, ScienceDirect, Google Scholar and DOAJ by applying the Boolean term method. Statistical analyses and risk of bias assessment were calculated through RevMan 5.4.1 and the Newcastle Ottawa Scale (NOS), respectively. Outcomes were presented as odds ratio (OR).
Results: A total of 6 studies were included, encompassing 527 patients who were diagnosed with penile fracture and underwent surgery for repairment. Risk factors for post-surgery erectile dysfunction were calculated. Age (OR = 0.19, 95% CI [0.07, 0.52], p=0.001), location of fracture (OR = 0.43, 95% CI [0.22, 0.84], p=0.01), and side of fracture (OR = 0.06, 95% CI [0.02, 0.21], p<0.0001) have significant relations with erectile dysfunction. Whereas aetiology, urethral injury, and timing of presentation have statistically non significant effect on the incidence of erectile dysfunction.
Conclusions: This systematic review and meta-analysis showed that patients over 50 years of age, those with midshaft fracture, and those with bilateral fractures are significantly more likely to have erectile dysfunction following penile fracture surgery.
Downloads
Download data is not yet available.
1. Arikan MG, Akgul B, Turk S, et al. Beyond conventional wisdom: unexplored risk factors for penile fracture. Sex Med. 2024;12:qfae068. DOI: https://doi.org/10.1093/sexmed/qfae068
2. Sheikh BA, Porwal P. Successful surgical repair of a 26-day old penile fracture. Indian J Plast Surg. 2024; 57:233-234. DOI: https://doi.org/10.1055/s-0044-1785670
3. Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2005;32:379-95, DOI: https://doi.org/10.1016/j.ucl.2005.08.007
4. von Stempel C, Kirkham A, Cayetano Alcaraz A, et al. Imaging findings in suspected penile fracture: alternative diagnoses and surgical correlation. Br J Radiol. 2024; 97:1850-1855. DOI: https://doi.org/10.1093/bjr/tqae167
5. Kajerero V, Sukunala O, Rugakingira RA, et al. Penile fracture following sexual intercourse; A case report and literature review. Int J Surg Case Rep. 2023; 108:108415. DOI: https://doi.org/10.1016/j.ijscr.2023.108415
6. Barros R, Schul A, Cavalcanti AG, et al. Findings regarding nonsexual penile fracture in a referral emergency hospital. Int Braz J Urol. 2021; 47:388-94. DOI: https://doi.org/10.1590/s1677-5538.ibju.2020.0420
7. Bolat MS, Özen M, Önem K, et al. Effects of penile fracture and its surgical treatment on psychosocial and sexual function. Int J Impot Res. 2017; 29:244-9. DOI: https://doi.org/10.1038/ijir.2017.31
8. El-Assmy A, El-Tholoth HS, Mohsen T, Ibrahiem EHI. Does timing of presentation of penile fracture affect outcome of surgical intervention? Urology. 2011; 77:1388-91. DOI: https://doi.org/10.1016/j.urology.2010.12.070
9. Zhu J, Tang Y, Zhu S, et al. Surgical outcomes in penile fractures: A single center experience in China. Heliyon 2024;10:e37260. DOI: https://doi.org/10.1016/j.heliyon.2024.e37260
10. Chaker K, Gharbia N, Ouanes Y, et al. Sexual outcomes following the surgical treatment of traumatic rupture of the corpora cavernosa. Int Urol Nephrol. 2025;57:1063-1068. DOI: https://doi.org/10.1007/s11255-024-04285-1
11. Patil B, Kamath S, Patwardhan S, Savalia A. Importance of time in management of fracture penis: A prospective study. Urol Ann. 2019; 11:405-9. DOI: https://doi.org/10.4103/UA.UA_80_18
12. Sharma G, Mandal S, Bhowmik P, et al. Sexual function outcomes and risk factors of erectile dysfunction after surgical repair of penile fracture. Turk J Urol. 2021; 47:106-12. DOI: https://doi.org/10.5152/tud.2020.20311
13. GamalEl Din SF, Nabil N, Ragab MW, et al. Role of penile rehabilitation through daily intake of 5 mg tadalafil on erectile dysfunction after different presentations of penile fracture: a prospective case-control study. Int Urol Nephrol. 2023; 55:2781-7. DOI: https://doi.org/10.1007/s11255-023-03713-y
14. Al-Shaiji TF AJBGB. Al-Shaiji TF, Amann J, Brock GB. Fractured penis: diagnosis and management. J Sex Med 2009; 6: 3231-3240. DOI: https://doi.org/10.1111/j.1743-6109.2009.01593.x
15. El-Assmy A, El-Tholoth HS, Abou-El-Ghar ME, et al. Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture. Int J Impot Res. 2012; 24:20-5. DOI: https://doi.org/10.1038/ijir.2011.41
16. Barros R, Schul A, Ornellas P, et al. Impact of surgical treatment of penile fracture on sexual function. Urology. 2019; 126:128-33. DOI: https://doi.org/10.1016/j.urology.2018.11.047
17. Grima F PPDMPPCJRA. Management of corpus cavernosum trauma. Prog Urol 2007; 16: 12-18.
18. Hinev A. Fracture of the penis: treatment and complications. Acta Med Okayama 2000; 54: 211-216.
19. Penson DF, Seftel AD, Krane RJ, et al. The hemodynamic pathophysiology of impotence following blunt trauma to the erect penis. J Urol 1992;148: 1171-1180. DOI: https://doi.org/10.1016/S0022-5347(17)36852-0
20. Mansi MK, Emran M, el-Mahrouky A, el-Mateet MS. Experience with penile fractures in Egypt: long-term results of immediate surgical repair. J Trauma 1993;35:67-70. DOI: https://doi.org/10.1097/00005373-199307000-00011
21. Ibrahiem eH, el-Tholoth HS, Mohsen T, et al. Penile fracture: long term outcome of immediate surgical intervention. Urology 2010; 75: 108-111. DOI: https://doi.org/10.1016/j.urology.2009.08.057
22. Zargooshi J. Penile fracture in Kermanshah, Iran: the longterm results of surgical treatment. BJU Int 2002; 89: 890-894. DOI: https://doi.org/10.1046/j.1464-410X.2002.02745.x
23. Avci IE, Yilmaz H, Cinar NB, et al. Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes. Sex Med 2023;11:qfad048. DOI: https://doi.org/10.1093/sexmed/qfad048
24. Ortac M, Özgor F, Caglar U, et al. Older age and a large tunical tear may be predictors of increased erectile dysfunction rates following penile fracture surgery. Int J Impot Res. 2020; 32:226-31. DOI: https://doi.org/10.1038/s41443-019-0159-2
25. Costa Silva A, Rodrigues V, Martins Silva C, Morgado A. Complications after surgical correction of penile fractures—Is there a clinical impact? Andrology 2024;12:835-40. DOI: https://doi.org/10.1111/andr.13528
26. Ouanes Y, Saadi MH, Haj Alouene H, et al. Sexual function outcomes after surgical treatment of penile fracture. Sex Med. 2021; 9:100353. DOI: https://doi.org/10.1016/j.esxm.2021.100353
27. Dunna V, Giduturi SR, Chary KSN, et al. An unusual presentation of penile fracture with complete transection of urethra: a case report. J Surg Case Rep. 2024; 2024:rjae290. DOI: https://doi.org/10.1093/jscr/rjae290
28. Koifman L CAMC, et al. Penile fracture - experience in 56 cases. Int Braz J Urol 2003; 29:35-9. DOI: https://doi.org/10.1590/S1677-55382003000100007
29. Amer T WRCP, et al. Penile fracture: a meta- analysis. Urol Int 2016; 96:315-29. DOI: https://doi.org/10.1159/000444884
30. Penson DF, Seftel AD, Krane RJ, et al. The hemodynamic pathophysiology of impotence following blunt trauma to the erect penis. J Urol 1992; 148: 1171-1180. DOI: https://doi.org/10.1016/S0022-5347(17)36852-0
31. Bulbul E, Gultekin MH, Citgez S, et al. Penile fracture: Tertiary care center experience and long-term complications after immediate repair. Andrology. 2022;10:560-6. DOI: https://doi.org/10.1111/andr.13148
32. Wong NC, Dason S, Bansal RK, et al. Can it wait? A systematic review of immediate vs. delayed surgical repair of penile fractures. Can Urol Assoc J. 2017;11:53-60 DOI: https://doi.org/10.5489/cuaj.4032
33. Shebl SE. The presentation and outcomes of penile fracture with associated urethral injury: A systematic literature review. Arch Ital Urol Androl 2023;95:11082. DOI: https://doi.org/10.4081/aiua.2023.11082
34. Syarif S, Azis A, Natsir AS, Putra MZDA. What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis. Braz J Urol 2024; .50: 28-36. DOI: https://doi.org/10.1590/s1677-5538.ibju.2023.0419
35. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current management of penile fracture: an up-to-date systematic review. Sex Med Rev 2018; 6 253-60. DOI: https://doi.org/10.1016/j.sxmr.2017.07.009
36. Kominsky H, Beebe S, Shah N, Jenkins LC. Surgical reconstruction for penile fracture: a systematic review. Int J Impot Res. 2020; 32:75-80. DOI: https://doi.org/10.1038/s41443-019-0212-1
How to Cite
What are the risk factors for erectile dysfunction following penile fracture surgery? A systematic review and meta-analysis. (2025). Archivio Italiano Di Urologia E Andrologia, 97(3). https://doi.org/10.4081/aiua.2025.14195
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.