Unexplained Recurrent Nocturnal Urethral Bleeding: An Unusual Presentation of Penile Fracture

Introduction: Penile fracture is an emergency condition. Common presentation is classical history of trauma to erect penis followed by detumescence, penile swelling, ecchymosis and discoloration. Management is primarily surgical. We report our experience of such cases including a subgroup of patients with unexplained recurrent nocturnal urethral bleed without penile swelling and normal voiding.

Material and methods: This a retrospective study performed at our institution. Records of penile fracture cases managed over last 6 years were reviewed. Total of 63 patients were managed either by surgical (53 patients) or conservative (10 patients) approach. Sexual outcomes were measured with abbreviated International Index of Erectile Function (IIEF 5) questionnaire and compared with preoperative scores.

Results: Most common aetiology was coital trauma, seen in 88.9 % of patients. Mean age was 34.95 years. Urethral injury was present in 5 (9.4%) patients in the surgical group. Most common site of injury was ventrolateral {32 (60.4%)} over proximal shaft {49 (92.5%)}. Mean follow up was 19.27 months ranging from 6 to 41 months. Erectile function was preserved (no deterioration in IIEF 5 category) in 96.3 % and 100% of patients from surgical and conservative groups.

Conclusion: Unexplained recurrent nocturnal urethral bleed as a presentation of penile fracture, should be kept in mind. Such peculiar presentation, to our knowledge, has not been reported in literature. This subgroup of patients can be managed conservatively with good sexual and voiding functional outcome.

Keywords: Nocturnal urethral bleed; Penile fracture; Conservative management; Erectile dysfunction

Abbreviations: IIEF: International Index of Erectile Function; ED: Erectile Dysfunction