According to the results, the positions with the “man on top” and “doggy style” were considered the most severe, presenting greater association with urethral and bilateral lesions of the corpora cavernosa ( 14) Figure-1. A Brazilian study evaluated the relationship between sexual position and severity of PF in 90 patients. reported a retrospective analysis of 21 PF cases in Ireland and all fractures were the result of sexual misadventure ( 13). The incidence of urethral injury was higher in these countries, such as Brazil and the United States, because intercourse is generally associated with high-energy traumas. On the other hand, the incidence reached 38% in western countries where sexual intercourse represented the main cause of PF ( 12). Concomitant urethral injury was found in only five (1.6%) patients, corroborating the theory that non-coital injury has a lower incidence of urethral involvement due to low-energy trauma ( 11). described their experience with 300 cases of PF, with masturbation as etiology in 180 (60%) cases. In this series, there was combined penile and urethral rupture only in five cases ( 10). ![]() This is a self-inflicted injury, consisting of intentional forceful acute bending of part of the shaft of the erect penis in a downward, upward, or lateral direction while holding the other part stationary, to achieve detumescence of the penis, as a practice to release tension, among other reasons. In an Iranian study with 352 cases of PF, the main cause was the practice of taqaandan in 269 cases (76.4%). The incidence of urethral lesion in patients with PF was reported to be only 3% in Eastern European countries, Asia, and Africa, where the main cause was penile manipulation. Therefore, in this review, we present the evolution and the recent data on the etiology, diagnosis, management and outcomes of PF with concomitant urethral injury. It is important to address these issues in the urological literature. PF and urethral injury should be treated by surgery with the goal of preserving sexual potency and regaining normal micturition function ( 8, 9). Studies have variously reported the usefulness of retrograde urethrocystography (RGU), ultrasound (USG), flexible cystoscopy and magnetic resonance imaging (MRI) in the diagnosis ( 4- 7). Blood in the meatus, hematuria and urinary retention may be experienced with urethral injury ( 3). Patients usually report a cracking sound with concomitant sudden swelling and ecchymosis of the penis followed by immediate detumescence. The urethral lesion can be partial or complete and the incidence varies from 1% to 38%, depending the geographic region and etiology ( 1, 2). ![]() Penile fracture (PF) with associated urethral rupture is an extremely rare condition.
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