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Please note: This page is intended for healthcare professionals only. It is designed as a general educational guide and does not replace local guidance, senior clinical advice, or individual clinical judgement. Patients should not use this page as medical advice and should seek advice from an appropriate healthcare professional.

Penile Fracture

Rupture of one or both tunica albuginea of the corpus cavernosum. Approximately 25% have associated urethral injury.

Risk Factors

  • Blunt trauma to an erect penis (usually during intercourse)
  • Also occurs during: masturbation or deliberate bending of the erect penis
  • Trauma to a flaccid penis rarely causes fracture

Presentation

  • Sudden severe penile pain
  • Characteristic 'cracking' or 'popping' sound at time of injury
  • Immediate detumescence with inability to continue intercourse
  • Gross swelling and haematoma developing ('Aubergine/Eggplant sign')
  • Occasional bleeding from urethra / blood in urine

Note: Not all features need to be present to make the diagnosis

Differential diagnosis

  • Not all penile bruising following coitus will be a penile fracture.
  • Bruising can also be caused by:
    • Superficial vein rupture/superficial haematoma
    • Suspensory ligament rupture

Assessment

  1. The history and clinical examination should confirm the diagnosis in most cases
    1. Clarify time
    2. Mechanism
    3. Relevant past medical history and medications
  2. Focused penile examination looking for:
    1. Swelling and deformity
    2. Bruising pattern – confined to penis if Buck's fascia intact; may extend to scrotum, perineum, or lower abdominal wall if breached
    3. Tender, palpable defect over tunical rupture site
    4. Most common location: ventro-lateral aspect (thinnest part of tunica)
    5. Assessment for urethral injury: blood at meatus, haematuria, pain on voiding, urinary retention

Investigations

  1. Clinical diagnosis is key
  2. Imaging – will depend on local Radiology expertise and availability but do not delay surgery waiting for imaging
    1. Ultrasound - may help identify location and extent of tunical rupture
    2. MRI - reserved only for cases with persisting diagnostic doubt

Management

Immediate Management
  1. Call Urology SpR urgently
  2. Keep patient NBM
  3. Provide adequate analgesia
  4. Prepare for urgent surgical exploration and primary repair
Surgical Management Timeline
  • BAUS consensus recommends aiming for surgical repair within 24 hours of injury
  • Earlier intervention is indicated if there are signs of urethral injury
  • Prompt surgical repair improves outcomes and reduces complications including erectile dysfunction and penile curvature

BAUS patient information leaflet on Penile Fracture Repair - HERE

When to Escalate

  1. All suspected penile fractures require immediate Urology SpR involvement
  2. Any signs of urethral injury (blood at meatus, haematuria, retention) require even more urgent assessment
  3. Do not delay surgical exploration for imaging if clinical diagnosis is clear

References

  1. Rees RW, Brown G, Dorkin T, et al. British Association of Urological Surgeons (BAUS) consensus document for the management of male genital emergencies - penile fracture. BJU Int. 2018;122(1):26-28. Available from: https://doi.org/10.1111/bju.14167
  2. European Association of Urology. Urogenital Trauma Guidelines. In: EAU Guidelines on Urological Trauma [Internet]. Urogenital Trauma chapter. European Association of Urology; 2025. Available from: https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines