![]() ![]() Patient characteristics of interest included age, race, income quartile, payer status, substance abuse, psychiatric disorders, and other comorbidities ( Table 1). Patients with a diagnosis of PF were excluded from the appendectomy cohort. Thus, we identified men ≥18 years of age admitted with a diagnosis of appendicitis (ICD-9: 540.x, 541, 542 ICD-10: K35.x, K36, K37) and selected those who also underwent appendectomy. Appendectomy was chosen due to its widespread and less discriminatory nature as compared to other surgically managed diagnoses. We used male appendectomy as a comparison group to identify patient characteristics of significance associated with PF. We used the International Classification of Diseases, Ninth Revision – Clinical Modification (ICD-9-CM) and ICD-10-CM to identify all adults admitted with a diagnosis of PF (ICD-9: 959.13, ICD-10: S39840A). Independent variables and outcomes of interest ![]() We elected to focus on a large database of admitted patients to supplement the existing literature on emergency department patients, thereby adding robustness to what is known about the surgical acuity of PF. To address this gap in knowledge, we sought to characterize the temporal and demographic variations in the incidence, diagnostic evaluation, and surgical management of patients with penile fracture by performing a comparison to a control cohort of male patients admitted for appendectomy, a disease that indiscriminately affects the general population. 10, 11, 12 These are largely retrospective analyses that do not contextualize PF with respect to other surgical emergencies. In the last few years, several investigators have published series on PF that are country specific, treatment focused for a small cohort, or focused on emergency department settings. 7, 8, 9 Therefore, understanding the patient's presentation and diagnosis is critical to improving the delivery of care and outcomes. Details regarding the timing of surgical repair on erectile function remain controversial, but nevertheless can have lasting and profound psychosocial effects. The effects of PF can adversely impact the quality of life. 2, 3, 4 Imaging modalities to confirm the diagnosis, including magnetic resonance imaging (MRI) and ultrasound, have been described and may be helpful in equivocal cases however, the routine use of imaging remains controversial at present and is not routinely recommended. Guidelines from the American Urological Association (AUA), the European Association of Urology (EAU), and the British Association of Urological Surgeons (BAUS) all state that a history and physical examination consistent with PF is sufficient for surgical exploration and repair. This generally results in an audible snap and abrupt detumescence with associated pain and hematoma formation. 1 PF occurs when the erect penis is bent by a mechanical force, resulting in a tear in the tunica albuginea of the corpora cavernosa. Penile fracture (PF) is an uncommon but morbid urologic emergency requiring prompt evaluation and surgical intervention. Importantly, rates of substance abuse appear to be higher in the PF cohort compared with those of controls. PF occurs more commonly in a younger, healthier male population, and among minorities. PF rarely presented with hematuria (3.5%) however, urethral evaluation was performed in 23.1%, most commonly with cystoscopy (19.2%). Notably, PF patients had significantly higher rates of substance abuse (26.4% vs 18.1%, P ≤ 0.001), despite no difference in the diagnosed psychiatric disorders. Compared with the control cohort, PF patients were more likely to be younger (38.7 years vs 41.2 years, P ≤ 0.001), have lower rates of comorbidities except erectile dysfunction (1.4% vs 0.1%, P ≤ 0.001), and were more likely of Black race (25.4% vs 6.2%, P ≤ 0.001). The annual incidence of PF remained unchanged at 1.0–1.8 cases per 100 000 hospitalizations over the study period. During the study period, 5802 patients were hospitalized for PF. Presenting symptoms, rates of surgical repair, and rates of associated surgical procedures were evaluated in the PF cohort. Clinical and demographic data of the patients were compared with that of controls. Appendectomy patients were selected as a control cohort, given the non-discriminatory nature of this disease. The National Inpatient Sample was queried between the years 20 for patients with a diagnosis of PF. Given its rarity, we queried a national cohort over an 11-year period to study the temporal and demographic variations in presentation, evaluation, and management of patients with PF compared with a cohort of control patients. Penile fracture (PF) is a surgical emergency. ![]()
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