Abstract
This case series presents four cases of extreme proximal internal corpus cavernosum (EPICC) penile fractures. Patients, aged 33-53, presented with penile trauma primarily during sexual intercourse, exhibiting atypical symptoms sparing the penis but with significant perineal and scrotal bruising. Diagnosis was confirmed via penile magnetic resonance imaging (MRI), revealing fractures at the penile base. All patients underwent surgical repair through a midline perineal incision, with no long-term complications reported. This series highlights the value of MRI for diagnosing atypical fractures and supports a perineal surgical approach for optimal exposure and repair in EPICC fractures.