Penile injury repair (including fractured penis)

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or specialist nurse as well as the surgical team at Addenbrooke’s. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

Repair of the erectile tissue of the penis or re-attachment of the suspensory ligament of the penis, for damage occurring during sexual activity.

What are the alternatives to this procedure?

Observation, ice packs and compression.

What should I expect before the procedure?

Injury to the penis during sexual intercourse is unusual, but the erect penis can be damaged in several ways:

• 'fracture' of the penis due to forcible bending
• rupture of the suspensory ligament by forcible bending of the penis towards your feet
• thrombosis of the vein on the front of the penis (surgical treatment rarely required)

You will usually have been admitted to hospital as an emergency. Surgery is required on a semi-urgent basis and will only be performed once you have had nothing to eat or drink for a minimum of six hours.

A pre-medication will normally be prescribed by the anaesthetist one to two hours before the surgery; this will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for warfarin, aspirin, rivaroxaban, dabigatran, apixaban, edoxaban or clopidogrel, ticagrelor or blood thinning medication
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. Local anaesthetic infiltration is often used to relieve discomfort after the operation. The actual procedure performed will depend on the type of injury.

• Fracture of the penis: the skin of the penis is either opened over the defect or reflected backwards, the tear repaired and the skin replaced. In some cases a circumcision is necessary as part of this procedure.
• Rupture of the suspensory ligament: a small incision is usually made in the pubic hair at the base of the penis and the ligament re-attached with stitches.

What happens immediately after the procedure?

If you have undergone repair of a 'fractured' penis, it is normal to leave a bladder catheter in place for 24 to 48 hours after the procedure. This is removed before you go home. In the rare event of the urethra (water pipe) being damaged as well, you will need to keep your catheter for seven to 10 days.

You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used; these do not require removal.

The average hospital stay is three days.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in ten)

☐ There may be some shortening of the penis
☐ Possible dissatisfaction with the cosmetic or functional result.
☐ Temporary swelling and bruising of the penis and scrotum lasting several days.
☐ Stitches under the skin which you may be able to feel.
☐ Circumcision is sometimes required as part of the procedure.
☐ Insertion of a catheter into the bladder is sometimes necessary.

Occasional (between one in 10 and one in 50)

☐ Curvature at a later stage.
☐ Significant bleeding or infection requiring further treatment.
☐ Impotence or difficulty maintaining erections.
☐ Nerve injury with temporary or permanent numbness of penis.

Rare (less than one in 50)

☐ None.

What should I expect when I get home?

When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

It will be at least 14 days before healing occurs, you may return to work when you are comfortable enough and your GP is satisfied with your progress. You should refrain from sexual intercourse for a minimum of six weeks to allow complete healing.

What else should I look out for?

There will be marked swelling of the penis after a few days. This will last up to 10 days and will then subside, but do not be alarmed because this is expected. If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.

Are there any other important points?

A follow-up outpatient appointment will be arranged for you some six to eight weeks after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery. You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Privacy and dignity

Same-sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.

Hair removal before an operation

For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin, and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery. Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.

References:

NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)

Is there any research being carried out in this field at Addenbrooke’s Hospital?

There is no specific research in this area at the moment, but all operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist: 01223 586748
Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG): 01223 274608
Prostate cancer nurse practitioner: 01223 274608 or 01223 216897
Surgical care practitioner: 01223 348590 or 01223 256157

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients): 01223 274608
Urology nurse practitioner (stoma care): 01223 349800
Urology nurse practitioner (stone disease): 07860 781828

Patient advice and liaison service (PALS)

PALS, Box No 53, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email PALS

Chaplaincy and multi faith community

The Chaplaincy, Box No 105, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ
01223 217769
Email the Chaplaincy

MINICOM System ('type' system for the hard of hearing)

01223 217589

Access office (travel, parking and security information)

01223 596060