Postoperative Management After Penile Fracture Surgery: Intra-operative Drainage Does Not Reduce Early Morbidity After Penile Fracture Repair (FRACT AFUF project)

Postoperative Management After Penile Fracture Surgery: Intra-operative Drainage Does Not Reduce Early Morbidity After Penile Fracture Repair (FRACT AFUF project) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postoperative Management After Penile Fracture Surgery: Intra-operative Drainage Does Not Reduce Early Morbidity After Penile Fracture Repair (FRACT AFUF project) Norbert DE BREK, Arthur PEYROTTES, Charles DARIANE, Maxime PATTOU, and 36 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8071206/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Penile fracture is a rare urological emergency treated by surgical exploration. However, the indication for intra-operative drainage remains debated due to limited evidence. This study aimed to assess the impact of drainage on postoperative complications and symptoms after penile fracture repair. Methods: We performed a retrospective multicenter study including all patients who underwent surgery for clinically suspected penile fracture between 2000 and 2024 across 21 French centers. Patients were stratified according to intra-operative drain placement. The primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Operative time, hospital stay, and symptoms at 1 and 3 months were also evaluated. Multivariable logistic regression adjusted for surgical approach, urethral injury, and surgeon experience assessed associations with complications. Results: Among 519 patients, 158 (30%) received a drain. Drain placement was associated with longer operative time and hospital stay and more frequent degloving approach. The overall postoperative complication rate was 10%. Drain placement was not significantly associated with complications (OR 1.19, 95% CI 0.62–2.22; p = 0.59), whereas urethral injury was (OR 2.03; p = 0.04). At 1 month, 60% of patients reported at least one symptom; sexual pain was more frequent in the drain group (36% vs 23%; p = 0.04) but not at 3 months. Conclusion: Intra-operative drainage did not reduce early morbidity and was linked to longer operative time, hospital stay, and more sexual pain at 1 month. Drain use should therefore remain selective and tailored to intra-operative findings. Penile fracture Surgical drainage Postoperative complications Urethral injury Sexual pain Degloving approach Figures Figure 1 INTRODUCTION Penile fracture is a rare urological emergency, estimated at about 1 case per 100,000 men per year 1 , and is characterized by acute penile pain, immediate detumescence, and a cracking sound at the time of trauma. 2 Penile fracture may result from sexual trauma, but can also be caused by cultural practices such as “ Taqaandan” , a deliberate penile manipulation reported in certain Eastern countries. 3 Clinical presentation often includes a penile shaft hematoma and significant edema, described as “ eggplant-like” deformity. When these typical clinical signs are present, penile ultrasound can confirm and localize the rupture of the corpus cavernosum, with a sensitivity of nearly 80% and a specificity of more than 90%. 4,5 MRI can also be performed in unclear cases with good diagnostic performance (sensitivity 98%, specificity 80%). 6 Urgent surgical exploration remains the standard of care, allowing for hematoma evacuation and suturing of the corpus cavernosum, with ultrasound used selectively to assist lesion localization in equivocal cases. An associated urethral injury can be present in 6–18% of cases. 7,8 At the end of the surgery, the decision to place a surgical drain often depends on the surgeon's usual practice. Placement of a surgical drain may help prevent hematoma reformation, but this practice has shown no clear benefit in other urological procedures and is increasingly being excluded from standard protocols. 9,10 To our knowledge, no study has evaluated the impact of drainage on surgical complications. The objective of this study was to evaluate the impact of drainage on postoperative complications and symptoms. MATERIALS AND METHODS Study Design and Patient Population This study is based on data from a multicenter retrospective cohort of penile fracture cases conducted between 2000 and 2024 across 21 centers in France. All patients included had a clinical suspicion of penile fracture, with or without associated urethral injury. They all underwent surgical exploration, and cases without intraoperative confirmation of corpus cavernosum rupture were included. Etiology was not considered an inclusion criterion. Eligible cases were identified retrospectively from hospital databases across participating centers. Clinical variables, including patient demographic characteristics, surgical details, and follow-up data, were systematically extracted from comprehensive medical record reviews. Data Collection and Classification Erectile function was assessed using the 5-item version of the International Index of Erectile Function (IIEF-5), a validated self-administered questionnaire widely used to evaluate erectile dysfunction 11 . The total score ranges from 5 to 25, with lower scores indicating more severe dysfunction. Surgeon experience was classified as < 2 years, ≥ 2 years, and andrology subspecialist, defined as follows: surgeons with < 2 years of experience after completion of residency training; surgeons with ≥ 2 years of post-residency experience; and subspecialists whose main clinical activity was dedicated to andrology. Early complications were those occurring within 30 postoperative days and comprised any of the following: hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention. A priori, a key secondary ‘surgical-site composite’ complication was defined as hematoma, surgical-site infection, or wound dehiscence. Systemic infection was defined by fever or sepsis; surgical-site infection by a localized abscess or wound discharge. Events of Clavien–Dindo grade ≥ III were reported separately as major complications. Postoperative complications included hematoma, edema, urinary retention, systemic infection (characterized by fever or sepsis), and local infection (typically presenting as a localized abscesses or wound discharge). Early complications refer to events occurring during the first 30 postoperative days. Events of grade ≥ III, according to the Clavien-Dindo classification, were reported separately and considered major complications, as they required at least one surgical reintervention. 12 Follow-up duration was defined as the interval between the date of surgery and the most recent urology consultation documented in the medical record. Study endpoints The primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Secondary endpoints included operative time, length of hospital stay and the assessment of symptoms at 1 and 3 months between the drainage and non-drainage cohorts. Statistical Analysis Baseline characteristics were summarized using median and interquartile range (IQR) for continuous variables, and percentages for categorical variables. Chi-squared or Fisher’s exact tests were used for categorical variables, and Student’s t-test or Mann-Whitney U test were used for continuous variables, as appropriate. Multivariable logistic regression models were used to assess predictors of surgical complications and postoperative symptoms, including preoperative variables that differed significantly between groups, including confounders: surgeon experience, surgical approach, and urethral injury. The study period was assessed in sensitivity analyses to account for potential temporal effects. Concomitant circumcision (posthectomy) was excluded from the multivariable analysis because it may act as a mediating variable between the degloving surgical approach and postoperative outcomes, and due to the presence of missing data for this variable. All statistical analyses were two-sided, with a significance level set at 5%, and were performed using RStudio (version 4.4.2; R Foundation for Statistical Computing, Vienna, Austria). Complete-case analyses were used (see Table S1 for variable-level completeness). Ethical Considerations This study was conducted in accordance with institutional ethical standards. The protocol was approved by all participating ethics committees (RnIPH 2024-29) and comply with the reference methodology MR-004 of the French National Commission for Informatics and Liberties (Commission Nationale de l’Informatique et des Libertés, CNIL). No objection to participation in clinical research was noted in the patients’ medical files. RESULTS Patient demographics and baseline characteristics A total of 519 patients were included, with 158 (30%) receiving a drain and 342 (70%) treated without drainage. Four percent had a history of prior penile fracture, and sexual intercourse was the most common etiology. Baseline characteristics were comparable between groups regarding etiology, symptoms, and time to consultation. Imaging was performed in 56% of patients (ultrasound 45%, MRI 13%), with similar distribution between groups. Most procedures (54%) were performed by surgeons with less than two years of experience, and only 10% by andrology specialists. (Table 1) Surgical findings Operative time was significantly longer with drains (75 [IQR 60–98] vs 60 [IQR 45–80] minutes; p < 0.01), corresponding to a 20% increase in duration. (Table 1). This difference remained significant after exclusion of degloving procedures. (Table S2) The median lesion size was 15 mm, predominantly proximal (64%), and comparable between groups. An associated urethral injury was identified in 18% of patients. A non-degloving approach was used in 33% of cases, more often in the no-drain group (41% vs 14%; p < 0.01). Concomitant posthectomy was more frequent with drains (36% vs 24%; p < 0.01). Drain use remained stable across decades: 28% before 2010, 28% between 2010–2020, and 37% after 2020 (p = 0.14). (Figure S1) Postoperative outcomes Median length of stay was longer with drains (2 [IQR 2–3] vs 1 [IQR 1–2] days; p < 0.01), whereas catheterization duration was comparable. (Table 2) The overall early complication rate was 10% (n = 54) and did not differ significantly between groups (13% vs 9%; p = 0.21). (Table 1, figure 2) Major complications (Clavien–Dindo ≥ III) occurred in 5% of patients (8% vs 4%; p = 0.13). One postoperative death occurred in the no-drain group due to hypovolemia. In multivariable analysis, drain placement was not associated with complications (OR 1.19; 95% CI 0.62–2.22; p = 0.59), unlike urethral injury (OR 2.03; p = 0.04). The elective approach (OR 0.59; p = 0.16) and surgeon experience (OR 0.93; p = 0.83) were not significant predictors. (Table 3) The key secondary surgical-site composite (hematoma, infection, or wound dehiscence) showed similar results (OR 1.49; 95% CI 0.63–3.46). (Table S3) When restricted to the non-degloving approach, complications were more frequent with drains (26% vs 7%; p < 0.01). (Table S2) Findings were unchanged in the subset of intraoperatively confirmed fractures (n = 468). (Table S4) Postoperative symptoms at follow-up At 1 month, 63% (n = 326) of patients were evaluated; 60% reported at least one symptom, most commonly pain, penile curvature, palpable plaque, or erectile dysfunction. Sexual pain was significantly more frequent in the drain group (36% vs 23%; p = 0.04) and remained significant after adjustment for urethral injury and surgical approach (OR 2.01; 95% CI 1.1–3.8). The median IIEF-5 score was 19 [IQR 15–21] with drains and 23 [IQR 21–24] without (p = 0.19). At 3 months, 33% (n = 169) attended follow-up; 72% reported persistent symptoms, including palpable plaque (41%), sexual pain (34%), and curvature (30%), with no significant group difference. DISCUSSION To our knowledge, this study represents the largest series of surgically explored penile fractures to date and the first focusing on drainage management. In contrast to other trauma settings, the European Association of Urology guidelines on sexual trauma, published in 2023, make no recommendations regarding the use or avoidance of drains in penile fracture management, underscoring the lack of available data. 13 Our results show that the placement of a surgical drain is not associated with a reduction in early postoperative complications, but appears to be associated with increased surgical time, hospital stay and early postoperative sexual pain. Regarding the generalizability of our findings, the study population appears comparable to other European cohorts on penile fracture, with sexual intercourse being the leading cause (> 80% of cases). Ultrasound was the primary imaging modality employed, and associated urethral injury was identified in approximately 20% of patients. 8,14 Although drains are commonly used to prevent hematoma and collection formation by evacuating residual fluids or blood, our findings do not support this rationale. We observed similar rates of hematoma between groups. Conversely, in our series, local infection occurred in 4% of patients in the drain group versus 1% in the no-drain group, although this difference was not statistically significant. This difference could reach statistical significance in a larger study. Drains may represent a potential source of bacterial contamination and could increase the risk of local infection. A protocol involving early drain removal (within 12 hours) may reduce local infections. In a meta-analysis 7 including over 3000 patients, Amer et al. reported a rate of surgical complications of 20%, and only 0.24% for infectious complications. The higher rate observed in our study may be explained by the quality of data collection and the inclusion of minor events such as localized abscesses, requiring only outpatient care. Furthermore, the use of surgical drains appears to prolong hospital stay and may hinder the possibility of outpatient management, which is feasible for some of these young patients 15,16 , and is known to reduce iatrogenic risks and healthcare costs in urologic surgery. 17 Given the lack of evidence for any benefit in reducing postoperative complications, these findings highlight the added financial and human burden of drain use. The statistical association observed in the multivariate analysis between urethral injury and postoperative complications can be readily explained by the more invasive nature of procedures involving urethral injury, the need for prolonged urinary catheterization, and the likely greater severity of the initial trauma, highlighting the importance of including urethral injury in our multivariate analysis. These findings are consistent with those of other cohorts. 18 Moreover, we observed an increasing proportion of symptomatic patients over time, which highlights a potential follow-up bias: patients with persistent symptoms are more likely to return for consultation, whereas asymptomatic individuals may not attend follow-up visits. Our work has several limitations. First, this study is retrospective, and therefore subject to inherent methodological biases. For this reason, we limited our analysis to the most objective and consistently reported variables, such as IIEF score and Clavien-Dindo grading system. Furthermore, we were unable to account for potential center effects; nevertheless, the multicenter design reinforces the generalizability of our findings. In addition, functional outcomes at 3 months were available for only one-third of patients. Given that this condition primarily affects a young population and involves intimate concerns, this may contribute to limited follow-up. However, this loss of data is expected to be symmetrically distributed between groups. Furthermore, the decision to place a surgical drain at the end of the procedure may reflect not only standardized surgical protocols but also intraoperative findings – such as bleeding or tissue fragility – that are difficult to quantify and were not captured in the dataset. Future randomized studies would help clarify the potential clinical value of surgical drains in this setting. Conclusion In this multicenter cohort, intraoperative drainage did not reduce early morbidity and was associated with longer operative time and hospital stay, and with more sexual pain at 1 month. Our findings do not support routine drainage after penile fracture repair. In the absence of a proven protective effect, drain use should remain selective and tailored to the intraoperative context. The study was not powered to determine drainage effects within specific subgroups (e.g., concomitant urethral injury, large/bilateral ruptures); prospective studies are warranted. Declarations Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Competing interests: The authors declare that they have no relevant financial or non-financial interests to disclose. Ethics approval: A retrospective analysis of anonymized data from patients who underwent surgery for penile fracture between 2000 and 2024 was conducted across 21 French university hospitals. All clinical, surgical, and follow-up data were collected from medical records with strict confidentiality. All methods were performed in accordance with relevant guidelines and regulations. Consent to participate: For each patient, the absence of opposition to the use of clinical data for research purposes was verified in accordance with French regulations. Consent to publish: All authors approved the final version of the manuscript and consent to its submission to the World Journal of Urology . Funding/ Disclosures : None Author Contribution All authors contributed to the study conception and design. Data collection was performed by all participating investigators. The first draft of the manuscript was written by ND, and reviewed by CL, CD, and AP. All authors commented on previous versions of the manuscript, approved the final version, and agree to be accountable for all aspects of the work. Acknowledgement We gratefully acknowledge the AFUF team for their initiative and successful implementation of this project. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. References Rodriguez D, Li K, Apoj M, Munarriz R. Epidemiology of Penile Fractures in United States Emergency Departments: Access to Care Disparities May Lead to Suboptimal Outcomes. J Sex Med . 2019;16(2):248-256. doi:10.1016/j.jsxm.2018.12.009 Thompson RF. Rupture (fracture) of the penis. J Urol . 1954;71(2):226-229. doi:10.1016/S0022-5347(17)67779-6 Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med . 2009;6(4):1141-1150. doi:10.1111/j.1743-6109.2008.01117.x Martí de Gracia M, Muñiz Iriondo I, García Fresnadillo JP, Rodríguez Requena H, Matos A, Pinilla I. [Corpus cavernosum fracture: the ultrasound in the emergency diagnosis]. Radiologia . 2013;55(2):154-159. doi:10.1016/j.rx.2011.07.001 Yavuzsan AH, Albayrak AT, Yesildal C, et al. The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes. Int J Clin Pract . 2021;75(10):e14568. doi:10.1111/ijcp.14568 Wang H, Ananthapadmanabhan S, Saad J, et al. The Role of Magnetic Resonance Imaging in Penile Fracture Management—A Systematic Review. Société Int D’Urologie J . 2025;6(2):29. doi:10.3390/siuj6020029 Amer T, Wilson R, Chlosta P, et al. Penile Fracture: A Meta-Analysis. Urol Int . 2016;96(3):315-329. doi:10.1159/000444884 Barros R, Hampl D, Cavalcanti AG, Favorito LA, Koifman L. Lessons learned after 20 years’ experience with penile fracture. Int Braz J Urol Off J Braz Soc Urol . 2020;46(3):409-416. doi:10.1590/677-5538.IBJU.2019.0367 Chenam A, Yuh B, Zhumkhawala A, et al. Prospective randomised non‐inferiority trial of pelvic drain placement vs no pelvic drain placement after robot‐assisted radical prostatectomy. BJU Int . 2018;121(3):357-364. doi:10.1111/bju.14010 Kowalewski KF, Hendrie JD, Nickel F, et al. Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy. World J Urol . 2020;38(8):1905-1917. doi:10.1007/s00345-019-02978-2 Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res . 1999;11(6):319-326. doi:10.1038/sj.ijir.3900472 Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. Ann Surg . 2009;250(2):187-196. doi:10.1097/SLA.0b013e3181b13ca2 Serafetinidis E, Campos-Juanatey F, Hallscheidt P, et al. Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma. Eur Urol Focus . 2024;10(3):475-485. doi:10.1016/j.euf.2023.08.011 Koifman L, Barros R, Júnior RAS, Cavalcanti AG, Favorito LA. Penile fracture: diagnosis, treatment and outcomes of 150 patients. Urology . 2010;76(6):1488-1492. doi:10.1016/j.urology.2010.05.043 Gayito Adagba RA, Agbedey MS, Tengue K, et al. [Ambulatory treatment of penile fracture at teaching hospital in Lomé]. Progres En Urol J Assoc Francaise Urol Soc Francaise Urol . 2020;30(10):507-513. doi:10.1016/j.purol.2020.04.010 Moreno Sierra J, Garde Garcia H, Fernandez Perez C, et al. Surgical repair and analysis of penile fracture complications. Urol Int . 2011;86(4):439-443. doi:10.1159/000324249 Patel HD, Matlaga BR, Ziemba JB. Trends in the Setting and Cost of Ambulatory Urological Surgery: An Analysis of 5 States in the Healthcare Cost and Utilization Project. Urol Pract . 2019;6(2):79-85. doi:10.1016/j.urpr.2018.05.001 Phillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. Andrology . 2015;3(3):632-636. doi:10.1111/andr.12043 Tables Table 1: Demographic and clinical characteristics of the population. Total (n=519) Drain (n =158) No drain (n =342) Age, years, median [IQR] 42 [31-51] 42 [31-51] 42 [32-50] Anticoagulant use, n (%) 23 (4) 9 (4) 14 (6) History of penile fracture, n (%) 21 (4) 8 (5) 12 (4) Causes, n (%) Sexual intercourse Masturbation Taqaandan Trauma Other 416 (82) 14 (3) 41 (8) 36 (7) 3 (1) 125 (81) 5 (3) 11 (7) 13 (8) 1 (1) 274 (81) 9 (3) 30 (9) 22 (7) 2 (1) Symptoms, n (%) Cracking sound Loss of erection Pain Urethrorrhagia Hematoma 330 (78) 281 (69) 404 (83) 84 (17) 481 (95) 105 (78) 83 (70) 127 (85) 31 (20) 148 (96) 225(79) 193 (70) 262 (82) 50 (16) 317 (94) Time to consultation, hours, median [IQR] 3.0 [1.5-7.6] 3 [1.5-7.6] 3 [1.5-6.3] Surgeon experience, n (%) 2 yr Specialized in andrology 274 (54) 185 (36) 52 (10) 92 (59) 47 (30) 17 (11) 175 (51) 132 (39) 34 (10) Surgery duration, median [IQR] 60 [45-90] 75 [60-98] 60 [45-80] Size of lesion, median [IQR] 15 [10-20] 18.5 [10-25] 15 [10-20] Lesion side, n (%) Right Left Bilateral 261 (56) 145 (31) 59 (12) 84 (56) 45 (30) 21 (14) 171 (56) 97 (32) 36 (11) Lesion position, n (%) Proximal Middle Distal 245 (64) 89 (23) 48 (12) 68 (58) 31 (26) 18 (15) 175 (67) 57 (22) 30 (11) Associated urethral lesion, n (%) 89 (18) 33 (21) 51 (15) Surgical approach, n (%) Elective Degloving 165 (33) 338 (67) 23 (14) 133 (85) 138 (41) 195 (59) Associated posthectomy 138 (28) 55 (36) 81 (24) Patient characteristics, lesion features, and surgical details in the drain and no-drain groups. Data are presented as median [IQR] or n (%). Missing data explain the total discrepancy (see Table S1). IIEF-5 = International Index of Erectile Function Table 2: Postoperative complications and follow-up. Total (n=519) Drain (n =158) No drain (n =342) p-value Length of stay 2 [1-2.75] 2 [2-3] 1 [1-2] < 0.01 Length of catheterization 1 [1-2] 2 [1-4] 1 [1-1] 0.39 Postoperative complication, n (%) Total Surgical site infection Systemic infection Hematoma Local (wound dehiscence, oedema, ect) Other 54 (10) 11 (4) 8 (2) 6 (1) 24 (5) 3 (0.5) 20 (13) 6 (4) 4 (3) 2 (2) 8 (5) / 31 (9) 5 (1) 4 (1) 4 (1) 15 (4) 3 (1) 0.21 Severe complication (Clavien–Dindo ≥ III) 28 (5) 13 (8) 15 (4) 0.13 At 1 month (n = 326, 63%) At least one symptom Pain Sexual pain Penile curvature Palpable plaque Erectile dysfunction IIEF-5 Urethral stenosis 196 (60) 31 (10) 67 (27) 60 (19) 100 (34) 54 (17) 21 [18-24] 6 (2) 66 (62) 11 (11) 26 (36) 20 (19) 30 (31) 17 (17) 19 [15-21] 4 (4) 123 (59) 19 (9) 39 (23) 38 (20) 67 (36) 35 (17) 23 [21-24] 2 (1) 0.55 0.69 0.04 0.9 0.42 0.95 0.19 0.09 At 3 months (n = 169, 33%) At least one symptom Pain Sexual pain Penile curvature Palpable plaque Erectile dysfunction IIEF-5 Urethral stenosis 123 (67) 11 (7) 54 (34) 50 (30) 66 (39) 40 (24) 20 [18-22] 5 (3) 39 (65) 10 (17) 19 (35) 17 (31) 22 (40) 14 (23) 19 [18-20] 4 (7) 69 (67) 1 (1) 34 (35) 28 (31) 33 (41) 26 (26) 20 [19-23] 1 (1) 0.73 0.16 0.99 0.74 0.92 0.85 0.75 0.07 Postoperative outcomes and symptoms at 1 and 3 months according to surgical drainage. Data are presented as median [IQR] or n (%) IIEF-5 = International Index of Erectile Function Table 3. Univariate and multivariable analysis of preoperative factors associated with postoperative complications. OR 95% CI p OR 95% CI p Drain placement 1.45 0.79-2.62 0.22 1.19 0.62-2.22 0.59 Elective surgical approach 0.57 0.27-1.08 0.1 0.59 0.27-1.19 0.16 Associated urethral injury 1.97 1.01-3.7 0.04 2.03 1.01-3.92 0.04 Surgeon experience (> 2y) 0.87 0.49-1.55 0.64 0.93 0.51-1.71 0.83 * Odds ratios (OR), 95% confidence intervals (CI), and p-values from univariate and multivariable logistic regression models assessing associations between preoperative factors and the risk of postoperative complications. * Posthectomy not included in multivariable analysis (mediator with degloving approach; missing data). Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":89540,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRate of early postoperative complications between groups (≤ 30 days).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1postoperativecomplications.png","url":"https://assets-eu.researchsquare.com/files/rs-8071206/v1/5fe416899143d334f1355c5f.png"},{"id":107868968,"identity":"4537f0df-f21b-49bd-8c20-150c7730c781","added_by":"auto","created_at":"2026-04-27 07:35:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":427926,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8071206/v1/7ac6a8e1-7b9d-47b8-ba66-05290b7a4e18.pdf"},{"id":97371067,"identity":"e18ccae2-4bbb-4149-80bb-667c13fb43e5","added_by":"auto","created_at":"2025-12-03 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\u0026ldquo;\u003cem\u003eTaqaandan\u0026rdquo;\u003c/em\u003e, a deliberate penile manipulation reported in certain Eastern countries. \u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eClinical presentation often includes a penile shaft hematoma and significant edema, described as \u0026ldquo;\u003cem\u003eeggplant-like\u0026rdquo;\u003c/em\u003e deformity. When these typical clinical signs are present, penile ultrasound can confirm and localize the rupture of the corpus cavernosum, with a sensitivity of nearly 80% and a specificity of more than 90%. \u003csup\u003e4,5\u003c/sup\u003e MRI can also be performed in unclear cases with good diagnostic performance (sensitivity 98%, specificity 80%). \u003csup\u003e6\u003c/sup\u003e Urgent surgical exploration remains the standard of care, allowing for hematoma evacuation and suturing of the corpus cavernosum, with ultrasound used selectively to assist lesion localization in equivocal cases. An associated urethral injury can be present in 6\u0026ndash;18% of cases. \u003csup\u003e7,8\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAt the end of the surgery, the decision to place a surgical drain often depends on the surgeon's usual practice. Placement of a surgical drain may help prevent hematoma reformation, but this practice has shown no clear benefit in other urological procedures and is increasingly being excluded from standard protocols. \u003csup\u003e9,10\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTo our knowledge, no study has evaluated the impact of drainage on surgical complications. The objective of this study was to evaluate the impact of drainage on postoperative complications and symptoms.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Patient Population\u003c/h2\u003e\u003cp\u003eThis study is based on data from a multicenter retrospective cohort of penile fracture cases conducted between 2000 and 2024 across 21 centers in France. All patients included had a clinical suspicion of penile fracture, with or without associated urethral injury. They all underwent surgical exploration, and cases without intraoperative confirmation of corpus cavernosum rupture were included. Etiology was not considered an inclusion criterion. Eligible cases were identified retrospectively from hospital databases across participating centers. Clinical variables, including patient demographic characteristics, surgical details, and follow-up data, were systematically extracted from comprehensive medical record reviews.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection and Classification\u003c/h3\u003e\n\u003cp\u003eErectile function was assessed using the 5-item version of the International Index of Erectile Function (IIEF-5), a validated self-administered questionnaire widely used to evaluate erectile dysfunction \u003csup\u003e11\u003c/sup\u003e. The total score ranges from 5 to 25, with lower scores indicating more severe dysfunction.\u003c/p\u003e\u003cp\u003eSurgeon experience was classified as \u0026lt;\u0026thinsp;2 years, \u0026ge;\u0026thinsp;2 years, and andrology subspecialist, defined as follows: surgeons with \u0026lt;\u0026thinsp;2 years of experience after completion of residency training; surgeons with \u0026ge;\u0026thinsp;2 years of post-residency experience; and subspecialists whose main clinical activity was dedicated to andrology.\u003c/p\u003e\u003cp\u003eEarly complications were those occurring within 30 postoperative days and comprised any of the following: hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention. A priori, a key secondary \u0026lsquo;surgical-site composite\u0026rsquo; complication was defined as hematoma, surgical-site infection, or wound dehiscence. Systemic infection was defined by fever or sepsis; surgical-site infection by a localized abscess or wound discharge. Events of Clavien\u0026ndash;Dindo grade\u0026thinsp;\u0026ge;\u0026thinsp;III were reported separately as major complications.\u003c/p\u003e\u003cp\u003ePostoperative complications included hematoma, edema, urinary retention, systemic infection (characterized by fever or sepsis), and local infection (typically presenting as a localized abscesses or wound discharge). Early complications refer to events occurring during the first 30 postoperative days. Events of grade\u0026thinsp;\u0026ge;\u0026thinsp;III, according to the Clavien-Dindo classification, were reported separately and considered major complications, as they required at least one surgical reintervention. \u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFollow-up duration was defined as the interval between the date of surgery and the most recent urology consultation documented in the medical record.\u003c/p\u003e\n\u003ch3\u003eStudy endpoints\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Secondary endpoints included operative time, length of hospital stay and the assessment of symptoms at 1 and 3 months between the drainage and non-drainage cohorts.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eBaseline characteristics were summarized using median and interquartile range (IQR) for continuous variables, and percentages for categorical variables. Chi-squared or Fisher\u0026rsquo;s exact tests were used for categorical variables, and Student\u0026rsquo;s t-test or Mann-Whitney U test were used for continuous variables, as appropriate. Multivariable logistic regression models were used to assess predictors of surgical complications and postoperative symptoms, including preoperative variables that differed significantly between groups, including confounders: surgeon experience, surgical approach, and urethral injury.\u003c/p\u003e\u003cp\u003eThe study period was assessed in sensitivity analyses to account for potential temporal effects. Concomitant circumcision (posthectomy) was excluded from the multivariable analysis because it may act as a mediating variable between the degloving surgical approach and postoperative outcomes, and due to the presence of missing data for this variable.\u003c/p\u003e\u003cp\u003eAll statistical analyses were two-sided, with a significance level set at 5%, and were performed using RStudio (version 4.4.2; R Foundation for Statistical Computing, Vienna, Austria). Complete-case analyses were used (see Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e for variable-level completeness).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e This study was conducted in accordance with institutional ethical standards. The protocol was approved by all participating ethics committees (RnIPH 2024-29) and comply with the reference methodology MR-004 of the French National Commission for Informatics and Liberties (Commission Nationale de l\u0026rsquo;Informatique et des Libert\u0026eacute;s, CNIL). No objection to participation in clinical research was noted in the patients\u0026rsquo; medical files.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003ePatient demographics and baseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 519 patients were included, with 158 (30%) receiving a drain and 342 (70%) treated without drainage. Four percent had a history of prior penile fracture, and sexual intercourse was the most common etiology. Baseline characteristics were comparable between groups regarding etiology, symptoms, and time to consultation. Imaging was performed in 56% of patients (ultrasound 45%, MRI 13%), with similar distribution between groups. Most procedures (54%) were performed by surgeons with less than two years of experience, and only 10% by andrology specialists. (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOperative time was significantly longer with drains (75 [IQR 60–98] vs 60 [IQR 45–80] minutes; p \u0026lt; 0.01), corresponding to a 20% increase in duration. (Table 1). This difference remained significant after exclusion of degloving procedures. (Table S2) The median lesion size was 15 mm, predominantly proximal (64%), and comparable between groups. An associated urethral injury was identified in 18% of patients.\u003cbr\u003e\u0026nbsp;A non-degloving approach was used in 33% of cases, more often in the no-drain group (41% vs 14%; p \u0026lt; 0.01). Concomitant posthectomy was more frequent with drains (36% vs 24%; p \u0026lt; 0.01). Drain use remained stable across decades: 28% before 2010, 28% between 2010–2020, and 37% after 2020 (p = 0.14). (Figure S1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedian length of stay was longer with drains (2 [IQR 2–3] vs 1 [IQR 1–2] days; p \u0026lt; 0.01), whereas catheterization duration was comparable. (Table 2) The overall early complication rate was 10% (n = 54) and did not differ significantly between groups (13% vs 9%; p = 0.21). (Table 1, figure 2) Major complications (Clavien–Dindo ≥ III) occurred in 5% of patients (8% vs 4%; p = 0.13). One postoperative death occurred in the no-drain group due to hypovolemia.\u003c/p\u003e\n\u003cp\u003eIn multivariable analysis, drain placement was not associated with complications (OR 1.19; 95% CI 0.62–2.22; p = 0.59), unlike urethral injury (OR 2.03; p = 0.04). The elective approach (OR 0.59; p = 0.16) and surgeon experience (OR 0.93; p = 0.83) were not significant predictors. (Table 3) The key secondary surgical-site composite (hematoma, infection, or wound dehiscence) showed similar results (OR 1.49; 95% CI 0.63–3.46). (Table S3) When restricted to the non-degloving approach, complications were more frequent with drains (26% vs 7%; p \u0026lt; 0.01). (Table S2) Findings were unchanged in the subset of intraoperatively confirmed fractures (n = 468). (Table S4)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative symptoms at follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt 1 month, 63% (n = 326) of patients were evaluated; 60% reported at least one symptom, most commonly pain, penile curvature, palpable plaque, or erectile dysfunction. Sexual pain was significantly more frequent in the drain group (36% vs 23%; p = 0.04) and remained significant after adjustment for urethral injury and surgical approach (OR 2.01; 95% CI 1.1–3.8). The median IIEF-5 score was 19 [IQR 15–21] with drains and 23 [IQR 21–24] without (p = 0.19).\u003cbr\u003e\u0026nbsp;At 3 months, 33% (n = 169) attended follow-up; 72% reported persistent symptoms, including palpable plaque (41%), sexual pain (34%), and curvature (30%), with no significant group difference.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo our knowledge, this study represents the largest series of surgically explored penile fractures to date and the first focusing on drainage management.\u003c/p\u003e\u003cp\u003e In contrast to other trauma settings, the European Association of Urology guidelines on sexual trauma, published in 2023, make no recommendations regarding the use or avoidance of drains in penile fracture management, underscoring the lack of available data. \u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOur results show that the placement of a surgical drain is not associated with a reduction in early postoperative complications, but appears to be associated with increased surgical time, hospital stay and early postoperative sexual pain.\u003c/p\u003e\u003cp\u003eRegarding the generalizability of our findings, the study population appears comparable to other European cohorts on penile fracture, with sexual intercourse being the leading cause (\u0026gt;\u0026thinsp;80% of cases). Ultrasound was the primary imaging modality employed, and associated urethral injury was identified in approximately 20% of patients. \u003csup\u003e8,14\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAlthough drains are commonly used to prevent hematoma and collection formation by evacuating residual fluids or blood, our findings do not support this rationale. We observed similar rates of hematoma between groups. Conversely, in our series, local infection occurred in 4% of patients in the drain group versus 1% in the no-drain group, although this difference was not statistically significant. This difference could reach statistical significance in a larger study. Drains may represent a potential source of bacterial contamination and could increase the risk of local infection. A protocol involving early drain removal (within 12 hours) may reduce local infections. In a meta-analysis \u003csup\u003e7\u003c/sup\u003e including over 3000 patients, Amer et al. reported a rate of surgical complications of 20%, and only 0.24% for infectious complications. The higher rate observed in our study may be explained by the quality of data collection and the inclusion of minor events such as localized abscesses, requiring only outpatient care.\u003c/p\u003e\u003cp\u003eFurthermore, the use of surgical drains appears to prolong hospital stay and may hinder the possibility of outpatient management, which is feasible for some of these young patients \u003csup\u003e15,16\u003c/sup\u003e, and is known to reduce iatrogenic risks and healthcare costs in urologic surgery. \u003csup\u003e17\u003c/sup\u003e Given the lack of evidence for any benefit in reducing postoperative complications, these findings highlight the added financial and human burden of drain use.\u003c/p\u003e\u003cp\u003eThe statistical association observed in the multivariate analysis between urethral injury and postoperative complications can be readily explained by the more invasive nature of procedures involving urethral injury, the need for prolonged urinary catheterization, and the likely greater severity of the initial trauma, highlighting the importance of including urethral injury in our multivariate analysis. These findings are consistent with those of other cohorts. \u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMoreover, we observed an increasing proportion of symptomatic patients over time, which highlights a potential follow-up bias: patients with persistent symptoms are more likely to return for consultation, whereas asymptomatic individuals may not attend follow-up visits.\u003c/p\u003e\u003cp\u003eOur work has several limitations. First, this study is retrospective, and therefore subject to inherent methodological biases. For this reason, we limited our analysis to the most objective and consistently reported variables, such as IIEF score and Clavien-Dindo grading system. Furthermore, we were unable to account for potential center effects; nevertheless, the multicenter design reinforces the generalizability of our findings. In addition, functional outcomes at 3 months were available for only one-third of patients. Given that this condition primarily affects a young population and involves intimate concerns, this may contribute to limited follow-up. However, this loss of data is expected to be symmetrically distributed between groups.\u003c/p\u003e\u003cp\u003eFurthermore, the decision to place a surgical drain at the end of the procedure may reflect not only standardized surgical protocols but also intraoperative findings \u0026ndash; such as bleeding or tissue fragility \u0026ndash; that are difficult to quantify and were not captured in the dataset. Future randomized studies would help clarify the potential clinical value of surgical drains in this setting.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this multicenter cohort, intraoperative drainage did not reduce early morbidity and was associated with longer operative time and hospital stay, and with more sexual pain at 1 month. Our findings do not support routine drainage after penile fracture repair. In the absence of a proven protective effect, drain use should remain selective and tailored to the intraoperative context. The study was not powered to determine drainage effects within specific subgroups (e.g., concomitant urethral injury, large/bilateral ruptures); prospective studies are warranted.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003cp\u003eA retrospective analysis of anonymized data from patients who underwent surgery for penile fracture between 2000 and 2024 was conducted across 21 French university hospitals. All clinical, surgical, and follow-up data were collected from medical records with strict confidentiality. All methods were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent to participate:\u003c/h2\u003e\u003cp\u003eFor each patient, the absence of opposition to the use of clinical data for research purposes was verified in accordance with French regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to publish:\u003c/strong\u003e\u003cp\u003eAll authors approved the final version of the manuscript and consent to its submission to the \u003cem\u003eWorld Journal of Urology\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFunding/ Disclosures\u003c/b\u003e: None\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Data collection was performed by all participating investigators. The first draft of the manuscript was written by ND, and reviewed by CL, CD, and AP. All authors commented on previous versions of the manuscript, approved the final version, and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe gratefully acknowledge the AFUF team for their initiative and successful implementation of this project.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRodriguez D, Li K, Apoj M, Munarriz R. Epidemiology of Penile Fractures in United States Emergency Departments: Access to Care Disparities May Lead to Suboptimal Outcomes. \u003cem\u003eJ Sex Med\u003c/em\u003e. 2019;16(2):248-256. doi:10.1016/j.jsxm.2018.12.009\u003c/li\u003e\n\u003cli\u003eThompson RF. Rupture (fracture) of the penis. \u003cem\u003eJ Urol\u003c/em\u003e. 1954;71(2):226-229. doi:10.1016/S0022-5347(17)67779-6\u003c/li\u003e\n\u003cli\u003eZargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. \u003cem\u003eJ Sex Med\u003c/em\u003e. 2009;6(4):1141-1150. doi:10.1111/j.1743-6109.2008.01117.x\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute; de Gracia M, Mu\u0026ntilde;iz Iriondo I, Garc\u0026iacute;a Fresnadillo JP, Rodr\u0026iacute;guez Requena H, Matos A, Pinilla I. [Corpus cavernosum fracture: the ultrasound in the emergency diagnosis]. \u003cem\u003eRadiologia\u003c/em\u003e. 2013;55(2):154-159. doi:10.1016/j.rx.2011.07.001\u003c/li\u003e\n\u003cli\u003eYavuzsan AH, Albayrak AT, Yesildal C, et al. The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes. \u003cem\u003eInt J Clin Pract\u003c/em\u003e. 2021;75(10):e14568. doi:10.1111/ijcp.14568\u003c/li\u003e\n\u003cli\u003eWang H, Ananthapadmanabhan S, Saad J, et al. The Role of Magnetic Resonance Imaging in Penile Fracture Management\u0026mdash;A Systematic Review. \u003cem\u003eSoci\u0026eacute;t\u0026eacute; Int D\u0026rsquo;Urologie J\u003c/em\u003e. 2025;6(2):29. doi:10.3390/siuj6020029\u003c/li\u003e\n\u003cli\u003eAmer T, Wilson R, Chlosta P, et al. Penile Fracture: A Meta-Analysis. \u003cem\u003eUrol Int\u003c/em\u003e. 2016;96(3):315-329. doi:10.1159/000444884\u003c/li\u003e\n\u003cli\u003eBarros R, Hampl D, Cavalcanti AG, Favorito LA, Koifman L. Lessons learned after 20 years\u0026rsquo; experience with penile fracture. \u003cem\u003eInt Braz J Urol Off J Braz Soc Urol\u003c/em\u003e. 2020;46(3):409-416. doi:10.1590/677-5538.IBJU.2019.0367\u003c/li\u003e\n\u003cli\u003eChenam A, Yuh B, Zhumkhawala A, et al. Prospective randomised non‐inferiority trial of pelvic drain placement vs no pelvic drain placement after robot‐assisted radical prostatectomy. \u003cem\u003eBJU Int\u003c/em\u003e. 2018;121(3):357-364. doi:10.1111/bju.14010\u003c/li\u003e\n\u003cli\u003eKowalewski KF, Hendrie JD, Nickel F, et al. Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy. \u003cem\u003eWorld J Urol\u003c/em\u003e. 2020;38(8):1905-1917. doi:10.1007/s00345-019-02978-2\u003c/li\u003e\n\u003cli\u003eRosen RC, Cappelleri JC, Smith MD, Lipsky J, Pe\u0026ntilde;a BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. \u003cem\u003eInt J Impot Res\u003c/em\u003e. 1999;11(6):319-326. doi:10.1038/sj.ijir.3900472\u003c/li\u003e\n\u003cli\u003eClavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. \u003cem\u003eAnn Surg\u003c/em\u003e. 2009;250(2):187-196. doi:10.1097/SLA.0b013e3181b13ca2\u003c/li\u003e\n\u003cli\u003eSerafetinidis E, Campos-Juanatey F, Hallscheidt P, et al. Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma. \u003cem\u003eEur Urol Focus\u003c/em\u003e. 2024;10(3):475-485. doi:10.1016/j.euf.2023.08.011\u003c/li\u003e\n\u003cli\u003eKoifman L, Barros R, J\u0026uacute;nior RAS, Cavalcanti AG, Favorito LA. Penile fracture: diagnosis, treatment and outcomes of 150 patients. \u003cem\u003eUrology\u003c/em\u003e. 2010;76(6):1488-1492. doi:10.1016/j.urology.2010.05.043\u003c/li\u003e\n\u003cli\u003eGayito Adagba RA, Agbedey MS, Tengue K, et al. [Ambulatory treatment of penile fracture at teaching hospital in Lom\u0026eacute;]. \u003cem\u003eProgres En Urol J Assoc Francaise Urol Soc Francaise Urol\u003c/em\u003e. 2020;30(10):507-513. doi:10.1016/j.purol.2020.04.010\u003c/li\u003e\n\u003cli\u003eMoreno Sierra J, Garde Garcia H, Fernandez Perez C, et al. Surgical repair and analysis of penile fracture complications. \u003cem\u003eUrol Int\u003c/em\u003e. 2011;86(4):439-443. doi:10.1159/000324249\u003c/li\u003e\n\u003cli\u003ePatel HD, Matlaga BR, Ziemba JB. Trends in the Setting and Cost of Ambulatory Urological Surgery: An Analysis of 5 States in the Healthcare Cost and Utilization Project. \u003cem\u003eUrol Pract\u003c/em\u003e. 2019;6(2):79-85. doi:10.1016/j.urpr.2018.05.001\u003c/li\u003e\n\u003cli\u003ePhillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. \u003cem\u003eAndrology\u003c/em\u003e. 2015;3(3):632-636. doi:10.1111/andr.12043\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Demographic and clinical characteristics of the population.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=519)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n =158)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo drain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n =342)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eAge, years, median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e42 [31-51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e42 [31-51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e42 [32-50]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eAnticoagulant use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e23 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e9 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e14 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eHistory of penile fracture, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e21 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e12 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eCauses, n (%)\u003c/p\u003e\n \u003cp\u003eSexual intercourse\u003c/p\u003e\n \u003cp\u003eMasturbation\u003c/p\u003e\n \u003cp\u003eTaqaandan\u003c/p\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e416 (82)\u003c/p\u003e\n \u003cp\u003e14 (3)\u003c/p\u003e\n \u003cp\u003e41 (8)\u003c/p\u003e\n \u003cp\u003e36 (7)\u003c/p\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e125 (81)\u003c/p\u003e\n \u003cp\u003e5 (3)\u003c/p\u003e\n \u003cp\u003e11 (7)\u003c/p\u003e\n \u003cp\u003e13 (8)\u003c/p\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e274 (81)\u003c/p\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003cp\u003e30 (9)\u003c/p\u003e\n \u003cp\u003e22 (7)\u003c/p\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eSymptoms, n (%)\u003c/p\u003e\n \u003cp\u003eCracking sound\u003c/p\u003e\n \u003cp\u003eLoss of erection\u003c/p\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003cp\u003eUrethrorrhagia\u003c/p\u003e\n \u003cp\u003eHematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e330 (78)\u003c/p\u003e\n \u003cp\u003e281 (69)\u003c/p\u003e\n \u003cp\u003e404 (83)\u003c/p\u003e\n \u003cp\u003e84 (17)\u003c/p\u003e\n \u003cp\u003e481 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105 (78)\u003c/p\u003e\n \u003cp\u003e83 (70)\u003c/p\u003e\n \u003cp\u003e127 (85)\u003c/p\u003e\n \u003cp\u003e31 (20)\u003c/p\u003e\n \u003cp\u003e148 (96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e225(79)\u003c/p\u003e\n \u003cp\u003e193 (70)\u003c/p\u003e\n \u003cp\u003e262 (82)\u003c/p\u003e\n \u003cp\u003e50 (16)\u003c/p\u003e\n \u003cp\u003e317 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eTime to consultation, hours, median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.0 [1.5-7.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 [1.5-7.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 [1.5-6.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eSurgeon experience, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 2 yr\u003c/p\u003e\n \u003cp\u003e\u0026gt; 2 yr\u003c/p\u003e\n \u003cp\u003eSpecialized in andrology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e274 (54)\u003c/p\u003e\n \u003cp\u003e185 (36)\u003c/p\u003e\n \u003cp\u003e52 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92 (59)\u003c/p\u003e\n \u003cp\u003e47 (30)\u003c/p\u003e\n \u003cp\u003e17 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e175 (51)\u003c/p\u003e\n \u003cp\u003e132 (39)\u003c/p\u003e\n \u003cp\u003e34 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eSurgery duration, median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e60 [45-90]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e75 [60-98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e60 [45-80]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eSize of lesion, median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;15 [10-20]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e18.5 [10-25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e15 [10-20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eLesion side, n (%)\u003c/p\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e261 (56)\u003c/p\u003e\n \u003cp\u003e145 (31)\u003c/p\u003e\n \u003cp\u003e59 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84 (56)\u003c/p\u003e\n \u003cp\u003e45 (30)\u003c/p\u003e\n \u003cp\u003e21 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e171 (56)\u003c/p\u003e\n \u003cp\u003e97 (32)\u003c/p\u003e\n \u003cp\u003e36 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eLesion position, n (%)\u003c/p\u003e\n \u003cp\u003eProximal\u003c/p\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003cp\u003eDistal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e245 (64)\u003c/p\u003e\n \u003cp\u003e89 (23)\u003c/p\u003e\n \u003cp\u003e48 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (58)\u003c/p\u003e\n \u003cp\u003e31 (26)\u003c/p\u003e\n \u003cp\u003e18 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e175 (67)\u003c/p\u003e\n \u003cp\u003e57 (22)\u003c/p\u003e\n \u003cp\u003e30 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eAssociated urethral lesion, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e89 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e33 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e51 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eSurgical approach, n (%)\u003c/p\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003cp\u003eDegloving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e165 (33)\u003c/p\u003e\n \u003cp\u003e338 (67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (14)\u003c/p\u003e\n \u003cp\u003e133 (85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e138 (41)\u003c/p\u003e\n \u003cp\u003e195 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eAssociated posthectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e138 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e55 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e81 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePatient characteristics, lesion features, and surgical details in the drain and no-drain groups. Data are presented as median [IQR] or n (%). Missing data explain the total discrepancy (see Table S1).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIIEF-5 =\u0026nbsp;\u003c/em\u003eInternational Index of Erectile Function\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Postoperative complications and follow-up.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"681\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=519)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n =158)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo drain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n =342)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 313px;\"\u003e\n \u003cp\u003eLength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2 [1-2.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2 [2-3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 [1-2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 313px;\"\u003e\n \u003cp\u003eLength of catheterization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 [1-2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2 [1-4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 [1-1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 313px;\"\u003e\n \u003cp\u003ePostoperative complication, n (%)\u003c/p\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eSurgical site infection\u003c/p\u003e\n \u003cp\u003eSystemic infection\u003c/p\u003e\n \u003cp\u003eHematoma\u003c/p\u003e\n \u003cp\u003eLocal (wound dehiscence, oedema, ect)\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54 (10)\u003c/p\u003e\n \u003cp\u003e11 (4)\u003c/p\u003e\n \u003cp\u003e8 (2)\u003c/p\u003e\n \u003cp\u003e6 (1)\u003c/p\u003e\n \u003cp\u003e24 (5)\u003c/p\u003e\n \u003cp\u003e3 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;20 (13)\u003c/p\u003e\n \u003cp\u003e6 (4)\u003c/p\u003e\n \u003cp\u003e4 (3)\u003c/p\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003cp\u003e8 (5)\u003c/p\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (9)\u003c/p\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003cp\u003e4 (1)\u003c/p\u003e\n \u003cp\u003e4 (1)\u003c/p\u003e\n \u003cp\u003e15 (4)\u003c/p\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 313px;\"\u003e\n \u003cp\u003eSevere complication (Clavien\u0026ndash;Dindo \u0026ge; III) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e28 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e13 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 313px;\"\u003e\n \u003cp\u003eAt 1 month (n = 326, 63%)\u003c/p\u003e\n \u003cp\u003eAt least one symptom\u003c/p\u003e\n \u003cp\u003ePain\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSexual pain\u003c/p\u003e\n \u003cp\u003ePenile curvature\u003c/p\u003e\n \u003cp\u003ePalpable plaque\u003c/p\u003e\n \u003cp\u003eErectile dysfunction\u003c/p\u003e\n \u003cp\u003eIIEF-5\u003c/p\u003e\n \u003cp\u003eUrethral stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e196 (60)\u003c/p\u003e\n \u003cp\u003e31 (10)\u003c/p\u003e\n \u003cp\u003e67 (27)\u003c/p\u003e\n \u003cp\u003e60 (19)\u003c/p\u003e\n \u003cp\u003e100 (34)\u003c/p\u003e\n \u003cp\u003e54 (17)\u003c/p\u003e\n \u003cp\u003e21 [18-24]\u003c/p\u003e\n \u003cp\u003e6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66 (62)\u003c/p\u003e\n \u003cp\u003e11 (11)\u003c/p\u003e\n \u003cp\u003e26 (36)\u003c/p\u003e\n \u003cp\u003e20 (19)\u003c/p\u003e\n \u003cp\u003e30 (31)\u003c/p\u003e\n \u003cp\u003e17 (17)\u003c/p\u003e\n \u003cp\u003e19 [15-21]\u003c/p\u003e\n \u003cp\u003e4 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e123 (59)\u003c/p\u003e\n \u003cp\u003e19 (9)\u003c/p\u003e\n \u003cp\u003e39 (23)\u003c/p\u003e\n \u003cp\u003e38 (20)\u003c/p\u003e\n \u003cp\u003e67 (36)\u003c/p\u003e\n \u003cp\u003e35 (17)\u003c/p\u003e\n \u003cp\u003e23 [21-24]\u003c/p\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 313px;\"\u003e\n \u003cp\u003eAt 3 months (n = 169, 33%)\u003c/p\u003e\n \u003cp\u003eAt least one symptom\u003c/p\u003e\n \u003cp\u003ePain\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSexual pain\u003c/p\u003e\n \u003cp\u003ePenile curvature\u003c/p\u003e\n \u003cp\u003ePalpable plaque\u003c/p\u003e\n \u003cp\u003eErectile dysfunction\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;IIEF-5\u003c/p\u003e\n \u003cp\u003eUrethral stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e123 (67)\u003c/p\u003e\n \u003cp\u003e11 (7)\u003c/p\u003e\n \u003cp\u003e54 (34)\u003c/p\u003e\n \u003cp\u003e50 (30)\u003c/p\u003e\n \u003cp\u003e66 (39)\u003c/p\u003e\n \u003cp\u003e40 (24)\u003c/p\u003e\n \u003cp\u003e20 [18-22]\u003c/p\u003e\n \u003cp\u003e5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (65)\u003c/p\u003e\n \u003cp\u003e10 (17)\u003c/p\u003e\n \u003cp\u003e19 (35)\u003c/p\u003e\n \u003cp\u003e17 (31)\u003c/p\u003e\n \u003cp\u003e22 (40)\u003c/p\u003e\n \u003cp\u003e14 (23)\u003c/p\u003e\n \u003cp\u003e19 [18-20]\u003c/p\u003e\n \u003cp\u003e4 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69 (67)\u003c/p\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003cp\u003e34 (35)\u003c/p\u003e\n \u003cp\u003e28 (31)\u003c/p\u003e\n \u003cp\u003e33 (41)\u003c/p\u003e\n \u003cp\u003e26 (26)\u003c/p\u003e\n \u003cp\u003e20 [19-23]\u003c/p\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePostoperative outcomes and symptoms at 1 and 3 months according to surgical drainage. Data are presented as median [IQR] or n (%)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIIEF-5 =\u0026nbsp;\u003c/em\u003eInternational Index of Erectile Function\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Univariate and multivariable analysis of preoperative factors associated with postoperative complications.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eDrain placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.79-2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.62-2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eElective surgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.27-1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.27-1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eAssociated urethral injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1.01-3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1.01-3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eSurgeon experience (\u0026gt; 2y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.49-1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.51-1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e* Odds ratios (OR), 95% confidence intervals (CI), and p-values from univariate and multivariable logistic regression models assessing associations between preoperative factors and the risk of postoperative complications.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e* Posthectomy not included in multivariable analysis (mediator with degloving approach; missing data).\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Penile fracture, Surgical drainage, Postoperative complications, Urethral injury, Sexual pain, Degloving approach","lastPublishedDoi":"10.21203/rs.3.rs-8071206/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8071206/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e\u003cp\u003ePenile fracture is a rare urological emergency treated by surgical exploration. However, the indication for intra-operative drainage remains debated due to limited evidence. This study aimed to assess the impact of drainage on postoperative complications and symptoms after penile fracture repair.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eWe performed a retrospective multicenter study including all patients who underwent surgery for clinically suspected penile fracture between 2000 and 2024 across 21 French centers. Patients were stratified according to intra-operative drain placement. The primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Operative time, hospital stay, and symptoms at 1 and 3 months were also evaluated. Multivariable logistic regression adjusted for surgical approach, urethral injury, and surgeon experience assessed associations with complications.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eAmong 519 patients, 158 (30%) received a drain. Drain placement was associated with longer operative time and hospital stay and more frequent degloving approach. The overall postoperative complication rate was 10%. Drain placement was not significantly associated with complications (OR 1.19, 95% CI 0.62\u0026ndash;2.22; p\u0026thinsp;=\u0026thinsp;0.59), whereas urethral injury was (OR 2.03; p\u0026thinsp;=\u0026thinsp;0.04). At 1 month, 60% of patients reported at least one symptom; sexual pain was more frequent in the drain group (36% vs 23%; p\u0026thinsp;=\u0026thinsp;0.04) but not at 3 months.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eIntra-operative drainage did not reduce early morbidity and was linked to longer operative time, hospital stay, and more sexual pain at 1 month. Drain use should therefore remain selective and tailored to intra-operative findings.\u003c/p\u003e","manuscriptTitle":"Postoperative Management After Penile Fracture Surgery: Intra-operative Drainage Does Not Reduce Early Morbidity After Penile Fracture Repair (FRACT AFUF project)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 11:41:01","doi":"10.21203/rs.3.rs-8071206/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccf70dd7-f573-44cc-be6e-efcd8379bdff","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T09:59:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-03 11:41:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8071206","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8071206","identity":"rs-8071206","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}