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      Penile Fracture: Our Experience in a Tertiary Care Hospital

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          Abstract

          Purpose

          Penile fracture is rare, but it is a urological emergency that always requires immediate attention. Moreover, penile fracture has been reported more frequently in recent years. It may have devastating physical, functional, and psychological consequences if not properly managed in time.

          Materials and Methods

          The objective of this study was to highlight the causes, clinical presentation, and outcomes of cases of penile fracture. This was a prospective observational study extending from November 2012 to November 2014. Each patient underwent a thorough clinical evaluation and received proper treatment.

          Results

          Twenty patients with penile fracture, aged 19 to 56 years (mean, 28 years) were evaluated in this study. Vaginal intercourse was the most common mechanism of injury. Most of the patients (95%) were diagnosed clinically with a proper history and clinical examination. Nineteen patients were treated surgically. The patients underwent six months of follow-up, and were evaluated with local examinations, questionnaires, and colour Doppler ultrasonography as necessary.

          Conclusions

          Although penile fracture is an under-reported urological emergency, its incidence is increasing. It is usually diagnosed based on a clinical examination, but ultrasonography can be very helpful in diagnosis. Especially in cases where treatment is delayed, surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications.

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          Most cited references34

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          The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

          To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
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            Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.

            We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.
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              Fracture of the penis.

              N Eke (2002)
              Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial. A Medline search from January 1966 to July 2001 using the terms 'fracture of penis', 'penile trauma' and 'coital injuries' was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome. In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction. Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.
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                Author and article information

                Journal
                World J Mens Health
                World J Mens Health
                WJMH
                The World Journal of Men's Health
                Korean Society for Sexual Medicine and Andrology
                2287-4208
                2287-4690
                August 2015
                19 August 2015
                : 33
                : 2
                : 95-102
                Affiliations
                Department of Urology, Institute of Post-Graduate Medical Education and Research and SSKM Hospital, Kolkata, India.
                Author notes
                Correspondence to: Dilip Kumar Pal. Department of Urology, Institute of Post-Graduate Medical Education and Research and SSKM Hospital, Kolkata-700020, West Bengal, India. Tel: +91-33-22041388, Fax: +91-9433132553, urologyipgmer@ 123456gmail.com
                Article
                10.5534/wjmh.2015.33.2.95
                4550602
                26331126
                5dd4bb1b-829c-43f8-b784-37452b3dbba2
                Copyright © 2015 Korean Society for Sexual Medicine and Andrology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 April 2015
                : 26 April 2015
                : 28 April 2015
                Categories
                Original Article

                penile diseases,penile prosthesis,penis injuries,urogenital system

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