title: National Patterns of Urethral Evaluation and Risk Factors for Urethral Injury in Patients With Penile Fracture.
abstract: OBJECTIVE
  To examine the epidemiology and timing of penile fracture, patterns of urethral evaluation, and risk factors for concomitant urethral injury.
  
  
  METHODS
  The National Inpatient Sample (2003-2011) was used to identify patients with penile fractures. Clinical data included age, race, comorbidity, insurance, hospital factors, timing, hematuria, and urinary symptoms. Rates of formal urethral evaluation (cystoscopy or urethrogram) and urethral injury were calculated. Multivariate logistic regression was used to identify predictors of urethral evaluation and risk factors for urethral injury.
  
  
  RESULTS
  A weighted population of 3883 patients with penile fracture was identified. Presentations during weekends (37%) and summers (30%) were overrepresented (both P <.001). Urethral evaluation was performed in 882 patients (23%). Urethral injury was diagnosed in 813 patients (21%) with penile fracture. There was an increased odds of urethral evaluation with hematuria (odds ratio [OR] = 2.99; 95% confidence interval [CI], 1.03-8.73; P = .045) and a decrease for Hispanics (OR = 0.42; 95% CI, 0.22-0.82; P = .011). Older age (32-41 years: OR = 1.84; 95% CI, 1.07-3.16; P = .027; >41 years: OR = 2.25; 95% CI, 1.25-4.05; P = .007), black race (OR = 1.93; 95% CI, 1.12-3.34; P = .018), and hematuria (OR = 17.03; 95% CI, 3.20-90.54; P = .001) were independent risk factors for urethral injury.
  
  
  CONCLUSIONS
  Penile fractures, which occur disproportionately during summer and weekends, were associated with a 21% risk of urethral injury. Urethral evaluations were performed in a minority of patients. Even in patients with hematuria, 55% of patients underwent formal urethral evaluation. On multivariate analysis of patients with penile fracture, hematuria as well as older age and black race were independently associated with concomitant urethral injury.
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL. Electronic address: pariserj@gmail.com.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pariser
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Pearce
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Bales
mesh_terms: D000328:Adult; D006801:Humans; D015994:Incidence; D008297:Male; D010409:Penile Diseases / Q000150:complications / Q000453:epidemiology*; D010413:Penis / Q000293:injuries*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012421:Rupture; D014481:United States / Q000453:epidemiology; D014521:Urethra / Q000293:injuries*; D014522:Urethral Diseases / Q000453:epidemiology* / Q000209:etiology