Functional, Sexual and Psychosexual Outcomes After Penile Fracture Repair: A Scoping Review.

Penile fracture is a rare and underreported urological emergency, defined as traumatic rupture of the tunica albuginea of the corpus cavernosum. Most cases result from vigorous sexual intercourse or direct blunt trauma to an erect penis. While conservative management was once standard, high rates of long-term complications - including severe penile curvature, fibrotic plaques, and permanent erectile dysfunction (ED) - have led to a universal preference for immediate surgical repair. Although anatomical and physiological outcomes after surgery are well documented, the long-term psychosexual impact remains poorly characterised. Many patients report performance anxiety, fear of recurrence, and changes in sexual habits, but these experiences are often overlooked in favour of objective hemodynamic assessments. This scoping review aims to map and synthesise current evidence on functional, sexual, and psychosexual outcomes after surgical repair of penile fractures. Specifically, it examines the impact of surgical timing on erectile function, identifies independent risk factors for postoperative ED, and evaluates psychological effects on sexual satisfaction, relationship dynamics, and ejaculatory function. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. Comprehensive searches were conducted in PubMed/MEDLINE, EMBASE, the Cochrane Library, SCOPUS, and Web of Science. Data charting included patient demographics, injury mechanisms, diagnostic methods, surgical timing, and validated psychometric assessments across nine core studies. Immediate surgical intervention, ideally within 24 hours, is the gold standard and is associated with lower postoperative ED rates (6.5% to 16.5%) than delayed surgery (up to 42.9%) and conservative management (up to 52.9%). Independent predictors of poor outcomes include age over 50, urethral injury, bilateral corporal involvement, and tunical defects larger than 2 centimetres. Early repair reduces scarring and penile curvature. However, psychosexual outcomes remain complex. While erectile function is usually preserved, many patients experience psychogenic issues. Up to 77.5% report persistent fear of recurrence, and nearly 69% change their sexual habits. Changes in ejaculatory latency are also observed and correlate with higher depressive scores. Broad psychiatric screening tools do not show increased rates of clinical depression or generalised anxiety, indicating that psychological distress is specific to sexual performance and relationships. Immediate surgical repair remains the standard approach for preserving erectile function and anatomical integrity after penile fracture. However, postoperative recovery should not be assessed solely by structural or hemodynamic outcomes. The available evidence suggests that some patients experience persistent fear of recurrence, avoidance behaviours, performance anxiety, and reduced sexual confidence after repair. These findings highlight the need for more consistent assessment of psychosexual outcomes in follow-up studies. Multidisciplinary postoperative support, including psychological counselling, sexual health assessment, and partner-centred care, may be considered where clinically appropriate, but further research is needed to define optimal follow-up and rehabilitation strategies.