Inner Preputial Flap as Tunica Albuginea Replacement in The Management of Previously Untreated Fracture of The Penis

Objectives: To assess the efficacy of an inner preputial skin flap as replacement for the tunica albuginea of the corpus cavernosum after excision of fibrous plaque. Patients and Methods: In this retrospective study we evaluated 5 men who presented with impotence, chordee, painful erection and/or painful coitus after previously undiagnosed or untreated penile fracture. In two patients soft tissue X-rays suggested calcification of the plaque, while ultrasonography revealed extension of fibrosis in four cases. In all patients the plaque was excised and the defect in the tunica albuginea was closed with an inner preputial pedicle skin flap. Results: The flaps had taken well in all cases at 3 months follow-up and all patients reported having normal sexual intercourse. Conclusion: Surgical excision is the treatment of choice for management of symptomatic fibrous plaques occurring in undiagnosed, untreated or conservatively managed penile fracture. A defect of more than 1.5 cm after excision of the plaque requires tunica replacement, and an inner preputial flap is a good replacement.