Abstract
Penile fracture is a rare urological emergency that can lead to significant complications, particularly erectile dysfunction (ED). This systematic review aimed to evaluate the incidence of ED following penile fracture and assess management strategies. A comprehensive literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across multiple databases, including PubMed, EMBASE, Cochrane, SCOPUS, and Web of Science from inception to 2024. Studies reporting on ED incidence after penile fracture and comparing different management approaches were included. Quality assessment was performed using the QUADAS-2 tool. Studies with variable or insufficient data were excluded. Twenty-four studies involving 3,213 patients were included. The overall incidence of ED after penile fracture ranged from 0% to 52.9%, with immediate surgical repair showing significantly lower rates (6.6-16.5%) compared to conservative management (45.5-52.9%). Meta-analysis revealed that immediate surgical intervention (within 24-48 hours) was associated with lower ED rates (OR: 0.36, 95% CI: 0.15-0.89, P = 0.03) compared to delayed repair. Risk factors for post-operative ED included age >50 years (RR: 1.65, 95% CI: 1.14-2.39), bilateral corporal involvement, and concomitant urethral injury. Immediate surgical repair of penile fracture is associated with lower rates of ED compared to conservative management or delayed intervention. Early recognition and prompt surgical management within 24-48 hours are crucial for optimal functional outcomes.