Wong Nathan Colin, Dason Shawn, Bansal Rahul K, Davies Timothy O, Braga Luis H
Division of Urology, McMaster University, Hamilton, ON, Canada.
Can Urol Assoc J. 2017 Jan-Feb;11(1-2):53-60. doi: 10.5489/cuaj.4032.
Penile fractures have classically been thought to require immediate surgical intervention; however, recent series have described acceptable outcomes with delayed repair. In this systematic review, we compared complication rates between immediate and delayed repair of penile fractures.
A systematic search of MEDLINE, Embase, CENTRAL, and Web of Science was performed with predefined search terms between 1974 and 2015. Titles and abstracts were screened prior to full-text review and quality appraisal by two independent investigators. Abstracted outcomes included postoperative erectile dysfunction (ED), tunical scar formation, and penile curvature. Only studies reporting a direct comparison of complications following immediate (<24 hours from injury to presentation/surgery) and delayed (>24 hours) repair of penile fractures were included.
A total of 12 studies met inclusion criteria. All were retrospective, observational studies of low or moderate methodological quality. Of the reported 502 patients, 391 underwent immediate repair and 111 delayed repair. In the immediate repair group, the percent of patients with postoperative ED, tunical scars, and curvature were 6.6%, 5.4%, and 1.8%, respectively, while in the delayed group, the rates of ED, tunical scars, and curvature were 4.5% across the board. Rates of ED and tunical scar formation following immediate compared to delayed repair trended towards favouring immediate repair, but did not differ significantly, while rates of curvature significantly favoured immediate repair. However, cases of curvature were typically reported as mild and none affected sexual functioning.
In this systematic review, we demonstrated that ED and tunical scar formation rates between immediate and delayed repair of penile fractures were statistically similar, while immediate repair had a lower rate of penile curvature. Although this suggests that a brief delay in repair may be acceptable in select patients, the results should be interpreted with caution, as the included studies were of low or moderate methodological quality. Most importantly, this review highlights the deficiencies in the current penile fracture literature, setting the stage to improve the quality of future studies.
阴茎骨折传统上被认为需要立即进行手术干预；然而，最近的系列研究描述了延迟修复也可获得可接受的结果。在本系统评价中，我们比较了阴茎骨折立即修复和延迟修复的并发症发生率。
使用预定义的检索词对1974年至2015年期间的MEDLINE、Embase、CENTRAL和科学网进行系统检索。在全文审查和由两名独立研究人员进行质量评估之前，先对标题和摘要进行筛选。提取的结果包括术后勃起功能障碍（ED）、白膜瘢痕形成和阴茎弯曲。仅纳入报告了阴茎骨折立即修复（受伤至就诊/手术<24小时）和延迟修复（>24小时）后并发症直接比较的研究。
共有12项研究符合纳入标准。所有研究均为回顾性观察性研究，方法学质量低或中等。在报告的502例患者中，391例行立即修复，111例行延迟修复。立即修复组术后ED、白膜瘢痕和弯曲的患者百分比分别为6.6%、5.4%和1.8%，而延迟修复组ED、白膜瘢痕和弯曲的发生率均为4.5%。与延迟修复相比，立即修复后的ED和白膜瘢痕形成率倾向于支持立即修复，但差异无统计学意义，而弯曲率显著支持立即修复。然而，弯曲病例通常报告为轻度，且均未影响性功能。
在本系统评价中，我们证明阴茎骨折立即修复和延迟修复之间的ED和白膜瘢痕形成率在统计学上相似，而立即修复的阴茎弯曲率较低。虽然这表明在某些患者中短暂延迟修复可能是可以接受的，但由于纳入的研究方法学质量低或中等，结果应谨慎解释。最重要的是，本评价突出了当前阴茎骨折文献中的不足，为提高未来研究质量奠定了基础。
