Unusual complication of a Peyronie's disease plication, a penile fracture 3 weeks postoperatively: a case report and review of the literature

Unusual complication of a Peyronie's disease plication, a penile fracture 3 weeks postoperatively: a case report and review of the literature | 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 Case Report Unusual complication of a Peyronie's disease plication, a penile fracture 3 weeks postoperatively: a case report and review of the literature Lamine AMRANI, Hichem BROUGUI, Farid NECHICHE, Riad Hammadi Mahmoud MAIZ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8127206/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 Complications from surgery for Peyronie's disease are not uncommon (shortening, curvature and sensory disturbances of the penis, erectile dysfunction, infection), but penile fracture has not been reported until now. Based on a case of a penile fracture occurring shortly after a plication to correct a deformity caused by Peyronie's disease, we will describe the circumstances of this rare occurrence, its possible causes, and highlight the need for preventive measures. Peyronie's disease Fracture Complication Surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The prevalence of Peyronie's disease (PD) is 3.2%. Corrective surgery, when indicated, is not without complications: hematoma, infection, erectile dysfunction (ED), or penile fracture, which to our knowledge has not been described in the literature. We report our experience with a case of penile fracture occurring after surgical treatment of PD using a Nesbit plication. Case presentation We describe the case of a 67-year-old man who underwent surgery for PD with a 54° right lateral curvature of the penis (Fig. 1 ), causing significant psychological and sexual repercussions. He underwent surgical correction with two (02) Nesbit plications, with good immediate postoperative results (Fig. 2 ). He was readmitted three weeks later with a penile fracture following sexual intercourse 72 hours prior to admission, with a perceived cracking sound and immediate detumescence. Examination revealed a deformed penis with a predominantly subcoronal hematoma (Fig. 3 ). Surgical exploration revealed a 20 mm tear in the tunica albuginea in the left paraurethral area under the glans, away from the plication sites, which we sutured with 3 − 0 non-absorbable inverted dots (Fig. 4 ). He was discharged on day 3 with proerectile treatment starting on day 10. This complication did not impact the final outcome of the surgery; straightness was achieved and erectile function was preserved (International Index of Erectile Function IIEF5 score of 25) (Fig. 6). Discussion The tunica albuginea has a tensile strength of up to 1200 to 1500 mmHg, making it one of the strongest fascias in the body (1). Penile fracture is known to be a risk factor for developing PD, where trauma, or excessive bending of the penis when erect or flaccid can cause bleeding in the sub-tunic spaces, followed by fibrin deposition in the tunica albuginea, which is the initial consequence of microvascular damage and may be a precursor to plaque formation (2,3). However, no article in the literature has mentioned penile fracture after PD treatment. Nevertheless, Syed et al. (4) reported a case of suture failure during erection one week postoperatively, while Daitch et al. (5) described a similar case, but following the failure of sutures made with absorbable thread. Both authors indicate that these events did not impact the postoperative straightness that was achieved. In their review of the literature on complications following intraplaque injection of clostridium histolitycum collagenase (CCH), Hughes et al. (6) reported a penile fracture rate of between 0.3 and 4.9% in the series. This was due to the weakening of the tunica albuginea at the plaque following CCH injection, requiring special precautions when treating these fractures. In our case, the surgery would have weakened the penis following the incision and dissection of Buck's fascia, which gives the penis additional rigidity when the corpora cavernosa fill with blood during erection (1). The fracture may also have been caused by failure to observe the abstinence period required for healing of the various anatomical layers, which should be six (06) weeks, as well as sudden mechanical constraint during attempted penetration of his menopausal partner's unlubricated vaginal cavity. Conclusion Penile fracture occurring postoperatively following PD treatment is rare but remains possible. It could affect the outcome of reconstructive surgery, hence the importance of informing the patient of this risk and emphasizing preventive measures: observing the period of abstinence, resuming sexual intercourse cautiously, and using intimate lubricants. Abbreviations CCH : Collagénase clostridium histolitycum, IIEF : International Index of Erectile Function, PD : Peyronie’s disease. Declarations Conflicts of interest The authors declare no conflicts of interest. Ethics and consent to participate declarations The patient gave his consent for the publication of this case. Funding declaration No funding was received for this publication. Author Contribution All authors contributed to the writing of this article. Acknowledgement Pr Mustapha LOUNICIPr Rabah BENRABBAH References Cavallini G, Paulis G, éditeurs. Peyronie’s Disease [Internet]. Cham: Springer International Publishing; 2015. Disponible sur: http://link.springer.com/10.1007/978-3-319-17202-6 Jarow P, Lowe C. PENILE TRAUMA: AN ETIOLOGIC FACTOR IN PEYRONIE’S DISEASE AND ERECTILE DYSFUNCTION. Somers KD, Dawson DM. FIBRIN DEPOSITION IN PEYRONIE’S DISEASE PLAQUE. Syed AH, Abbasi Z, Hargreave TB. Nesbit procedure for disabling Peyronie’s curvature: a median follow-up of 84 months. Urology [Internet]. mai 2003 ;61(5):999‑1003. Disponible sur: https://linkinghub.elsevier.com/retrieve/pii/S0090429502025499 Daitch JA, Angermeier KW, Montague DK. MODIFIED CORPOROPLASTY FOR PENILE CURVATURE: LONG-TERM RESULTS AND PATIENT SATISFACTION. J Urol [Internet]. déc 1999;162(6):2006‑9. Disponible sur: http://www.jurology.com/doi/10.1016/S0022-5347%2805%2968088-3 Hughes WM, Natale C, Hellstrom WJG. The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy. Curr Urol Rep [Internet]. févr 2021;22(2):13. Disponible sur: http://link.springer.com/10.1007/s11934-020-01025-7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8127206","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":545998658,"identity":"f2d51a13-2b2f-48a7-a066-1ee74f59a77c","order_by":0,"name":"Lamine 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1","display":"","copyAsset":false,"role":"figure","size":371354,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative deformity caused by Peyronie's disease\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8127206/v1/08d7b2b61d12216d589c5ed0.png"},{"id":96365157,"identity":"1b70d625-5b70-426e-9226-117f84aeeeeb","added_by":"auto","created_at":"2025-11-20 10:10:03","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":828896,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative appearance and correction by Nesbit-type plication\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8127206/v1/20e1e1d1abc70b0f7176312e.jpeg"},{"id":96288237,"identity":"cd5e1448-c6ba-4de9-89a1-b53414a71309","added_by":"auto","created_at":"2025-11-19 12:11:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1020808,"visible":true,"origin":"","legend":"\u003cp\u003eAppearance of the penile fracture 3 weeks after surgery\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8127206/v1/0150469c91d7b54abb554ffb.png"},{"id":96288241,"identity":"7b6fab63-16b9-42bf-a128-35c812745a0c","added_by":"auto","created_at":"2025-11-19 12:11:00","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":964993,"visible":true,"origin":"","legend":"\u003cp\u003eintraoperative aspects of surgical repair of penile fracture\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8127206/v1/e1be297d02f544b1f95cd0c2.jpeg"},{"id":96288243,"identity":"a5652d23-2ab3-49ba-9c29-6acbe37553ff","added_by":"auto","created_at":"2025-11-19 12:11:00","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":844289,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative view showing the straightness of the penis\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8127206/v1/25730aae02a043fb4290a43a.jpeg"},{"id":96913118,"identity":"365c2de3-7ad6-446d-bb34-98c618264d80","added_by":"auto","created_at":"2025-11-27 13:52:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4902936,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8127206/v1/35142b13-23a6-4c2b-8907-e0d63846e562.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eUnusual complication of a Peyronie's disease plication, a penile fracture 3 weeks postoperatively: a case report and review of the literature\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of Peyronie's disease (PD) is 3.2%. Corrective surgery, when indicated, is not without complications: hematoma, infection, erectile dysfunction (ED), or penile fracture, which to our knowledge has not been described in the literature. We report our experience with a case of penile fracture occurring after surgical treatment of PD using a Nesbit plication.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eWe describe the case of a 67-year-old man who underwent surgery for PD with a 54\u0026deg; right lateral curvature of the penis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), causing significant psychological and sexual repercussions. He underwent surgical correction with two (02) Nesbit plications, with good immediate postoperative results (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). He was readmitted three weeks later with a penile fracture following sexual intercourse 72 hours prior to admission, with a perceived cracking sound and immediate detumescence. Examination revealed a deformed penis with a predominantly subcoronal hematoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Surgical exploration revealed a 20 mm tear in the tunica albuginea in the left paraurethral area under the glans, away from the plication sites, which we sutured with 3\u0026thinsp;\u0026minus;\u0026thinsp;0 non-absorbable inverted dots (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). He was discharged on day 3 with proerectile treatment starting on day 10. This complication did not impact the final outcome of the surgery; straightness was achieved and erectile function was preserved (International Index of Erectile Function IIEF5 score of 25) (Fig.\u0026nbsp;6).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe tunica albuginea has a tensile strength of up to 1200 to 1500 mmHg, making it one of the strongest fascias in the body (1). Penile fracture is known to be a risk factor for developing PD, where trauma, or excessive bending of the penis when erect or flaccid can cause bleeding in the sub-tunic spaces, followed by fibrin deposition in the tunica albuginea, which is the initial consequence of microvascular damage and may be a precursor to plaque formation (2,3). However, no article in the literature has mentioned penile fracture after PD treatment. Nevertheless, Syed et al. (4) reported a case of suture failure during erection one week postoperatively, while Daitch et al. (5) described a similar case, but following the failure of sutures made with absorbable thread. Both authors indicate that these events did not impact the postoperative straightness that was achieved.\u003c/p\u003e\u003cp\u003eIn their review of the literature on complications following intraplaque injection of clostridium histolitycum collagenase (CCH), Hughes et al. (6) reported a penile fracture rate of between 0.3 and 4.9% in the series. This was due to the weakening of the tunica albuginea at the plaque following CCH injection, requiring special precautions when treating these fractures.\u003c/p\u003e\u003cp\u003eIn our case, the surgery would have weakened the penis following the incision and dissection of Buck's fascia, which gives the penis additional rigidity when the corpora cavernosa fill with blood during erection (1). The fracture may also have been caused by failure to observe the abstinence period required for healing of the various anatomical layers, which should be six (06) weeks, as well as sudden mechanical constraint during attempted penetration of his menopausal partner's unlubricated vaginal cavity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePenile fracture occurring postoperatively following PD treatment is rare but remains possible. It could affect the outcome of reconstructive surgery, hence the importance of informing the patient of this risk and emphasizing preventive measures: observing the period of abstinence, resuming sexual intercourse cautiously, and using intimate lubricants.\u003c/p\u003e"},{"header":"Abbreviations","content":"CCH : Collagénase clostridium histolitycum, IIEF : International Index of Erectile Function, PD : Peyronie’s disease."},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflicts of interest\u003c/h2\u003e\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics and consent to participate declarations\u003c/h2\u003e\u003cp\u003eThe patient gave his consent for the publication of this case.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003edeclaration\u003c/p\u003e\u003cp\u003eNo funding was received for this publication.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the writing of this article.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003ePr Mustapha LOUNICIPr Rabah BENRABBAH\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCavallini G, Paulis G, \u0026eacute;diteurs. Peyronie\u0026rsquo;s Disease [Internet]. Cham: Springer International Publishing; 2015. Disponible sur: http://link.springer.com/10.1007/978-3-319-17202-6\u003c/li\u003e\n\u003cli\u003eJarow P, Lowe C. PENILE TRAUMA: AN ETIOLOGIC FACTOR IN PEYRONIE\u0026rsquo;S DISEASE AND ERECTILE DYSFUNCTION.\u003c/li\u003e\n\u003cli\u003eSomers KD, Dawson DM. FIBRIN DEPOSITION IN PEYRONIE\u0026rsquo;S DISEASE PLAQUE.\u003c/li\u003e\n\u003cli\u003eSyed AH, Abbasi Z, Hargreave TB. Nesbit procedure for disabling Peyronie\u0026rsquo;s curvature: a median follow-up of 84 months. Urology [Internet]. mai 2003 ;61(5):999‑1003. Disponible sur: https://linkinghub.elsevier.com/retrieve/pii/S0090429502025499\u003c/li\u003e\n\u003cli\u003eDaitch JA, Angermeier KW, Montague DK. MODIFIED CORPOROPLASTY FOR PENILE CURVATURE: LONG-TERM RESULTS AND PATIENT SATISFACTION. J Urol [Internet]. d\u0026eacute;c 1999;162(6):2006‑9. Disponible sur: http://www.jurology.com/doi/10.1016/S0022-5347%2805%2968088-3\u003c/li\u003e\n\u003cli\u003eHughes WM, Natale C, Hellstrom WJG. The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy. Curr Urol Rep [Internet]. f\u0026eacute;vr 2021;22(2):13. Disponible sur: http://link.springer.com/10.1007/s11934-020-01025-7\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Peyronie's disease, Fracture, Complication, Surgery","lastPublishedDoi":"10.21203/rs.3.rs-8127206/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8127206/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eComplications from surgery for Peyronie's disease are not uncommon (shortening, curvature and sensory disturbances of the penis, erectile dysfunction, infection), but penile fracture has not been reported until now. Based on a case of a penile fracture occurring shortly after a plication to correct a deformity caused by Peyronie's disease, we will describe the circumstances of this rare occurrence, its possible causes, and highlight the need for preventive measures.\u003c/p\u003e","manuscriptTitle":"Unusual complication of a Peyronie's disease plication, a penile fracture 3 weeks postoperatively: a case report and review of the literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 12:10:55","doi":"10.21203/rs.3.rs-8127206/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":"a6898538-1956-429d-ae0a-22f32a7f4623","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-23T23:53:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 12:10:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8127206","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8127206","identity":"rs-8127206","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}