Immediate surgical repair is widely accepted as the therapy of choice in penile fracture. As recent reports show, good results can also be achieved in some patients with conservative management. It is unclear which patients will truly benefit from an operation. We retrospectively compared the long-term outcomes of surgical and conservative treatment in patients with penile fracture. In 22 years we treated 29 patients with penile fracture. A total of 12 patients were treated with immediate surgical repair and 17 patients were treated conservatively. Patient charts were reviewed and all patients had followup by interview with an additional clinical evaluation if the result was not completely satisfactory. Outcome was rated good, moderate or poor. Mean followup was 67 months. There was no statistical difference between patients in the surgery group and patients in the conservative group in regard to length of followup, age at presentation or length of hospital stay. In the surgery group and the conservative group 11 (92%) and 10 (59%) patients showed good outcome, respectively. Poor outcome was seen in 3 patients from the conservative group. Overall, immediate surgery yields excellent results and is superior to nonoperative treatment in the management of penile fracture. However, conservative therapy restricted to uncomplicated cases can lead to an equally good outcome.