THE University Hospital of the West Indies and the Kingston Public Hospital see at least one person with penile fracture each month, a few of which are repeat patients.

This disclosure was made yesterday by Dr Dean Wong, one of six residents in training at the Jamaica Urological Society (JUS) symposium at the Conference Centre in downtown Kingston. He was presenting on the delayed approach to managing penile fractures at the University Hospital of the West Indies.

Dr Wong told the Jamaica Observer that, though the actual incidence of penile fracture is generally unknown, he believes for such a small population it is high.

“Aggressive” sexual intercourse, he said, is the main cause of penile fractures, which is trauma to the tunica albuginea of the erect penis. However, other people report fractures during masturbation, rolling over in the morning and onto an erection, and in Mediterranean countries, according to Dr Wong, the penis is physically broken. He advised though that this is not seen in Jamaica.

He told the Observer that patients with penile fracture are generally between 20 and 50 years old.

Dr Wong, who was named this year’s JUS resident, presented on his area of research, which Dr Belinda Morrison of the JUS said is a move to get their residents to go beyond academic or clinical skills to also foster interest in research.

His study looked at using the delayed approach to managing penile fractures as opposed to immediate repair, which was being used. He told the Observer that it was the first time the delayed approach was being used, and that worldwide both the delayed and immediate approaches have never been compared directly.

In the delayed repair approach, once the patient presents, usually with complaints that they missed or slipped out during sexual intercourse and hit the penis against the woman’s thigh or pelvis, or sometimes they report that they heard or felt a pop and the penis becomes swollen, sometimes losing their erection immediately, they are sent home with analgesic to return on day seven.

Dr Wong said that retrospective observational studies have shown that a delayed repair at seven to 12 days after impact results in outcomes similar to the immediate repair approach.

“The seven (days) is important because that is the time allowed for inflammation to begin to settle down and be used as a direct localised indication…” he said. “…The inflammation site is very important… because that is what is used to identify the fracture site, and we cut directly over it.”

He explained that the objective of his study is to assess the outcomes of the delayed approach at the UWI between July and November 2014. The pain at the fracture site, presence or absence of a lump, new curvature, and erectile function, which are general complications with the procedure used to manage penile fracture, were all assessed. Four men who presented with a common history of presenting within the first 12 hours, reporting a missed entry during sexual intercourse, pain and swelling of the penis, and partially losing their erection, were selected for the study. He explained that patients were offered delayed repair and immediate repair, and that those selected opted for the delayed repair.

After the operation, the patients were advised to abstain from sexual activity for six weeks.

One of the four patients did not do the procedure because after he returned on the seventh day, his penis was back to normal, while another — who had sex three weeks after surgery instead of the advised six weeks — has a lump, but his erectile function is okay.

According to Dr Wong, overall, the delayed repair approach in the management of penile fracture is safe, it has comparative outcomes to what is currently used for treating penile fractures and it is less morbid.

Admitting that attempts have been made to figure out associated factors to advise patients on preventing or minimising penile fractures — whether through sexual positions, taking control of the woman by holding her pelvis during the act, or even using substances like alcohol during sexual intercourse — Dr Wong said it is difficult to state definitively how it can be avoided.

He, however, had a word of caution.

“Enjoy yourself, but don’t get too crazy and learn, especially for the repeat patients,” Dr Wong told the Observer.

Dr Wong said further study will be done in comparing the two methods directly to broaden the options for treatment offered as well as to explore the potential benefits.