title: Approach to management of penile fracture in men with underlying Peyronie's disease.
abstract: OBJECTIVE
  To report on a series of patients with Peyronie's disease (PD) who experienced a penile fracture, examining the history, presentation, and management. Additionally, we describe an unreported surgical technique implementing combined fracture repair and tunica plication. PD is an acquired inflammatory condition of the penis that can cause fibrotic, nonexpansile thickening of the tunica albuginea, resulting in a focal bend or narrowing on erection.
  
  
  METHODS
  From October 1999 to July 2003, 4 patients with nonsurgically treated PD had a penile fracture during sexual activity. The mean patient age was 43 years (range 29 to 52), with an average of 5.5 days (range 3 to 8) transpiring from the time of penile trauma to surgery in the men presenting early. Penile ultrasonography was used to locate the site of tunica laceration.
  
  
  RESULTS
  Either circumcising or ventral midline incisions were selected to treat these patients. During penile exploration, the tunica defect in the corpus cavernosum was identified and closed with 2-0 Maxon suture. Subsequent artificial erection displayed penile curvature in 3 patients, and plication was then performed to straighten the tunica angulation using 2-0 TiCron suture. The fourth patient had a minimal bend with slight waisting, not requiring plication. No perioperative complications occurred. These 4 patients regained their preoperative level of erectile rigidity with lasting nonpainful correction of their deformity.
  
  
  CONCLUSIONS
  Patients with PD who have a penile fracture are candidates for combined fracture repair and tunica plication at the same setting.
authors.affiliation: Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143, USA.
authors.forename: Thomas X
authors.initials: TX
authors.lastname: Minor
authors.forename: William O
authors.initials: WO
authors.lastname: Brant
authors.forename: Nadeem U
authors.initials: NU
authors.lastname: Rahman
authors.forename: Tom F
authors.initials: TF
authors.lastname: Lue
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010411:Penile Induration / Q000150:complications*; D010413:Penis / Q000000981:diagnostic imaging / Q000293:injuries*; D012725:Sexual Behavior; D014463:Ultrasonography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*