Penile fracture is a rare urologic injury defined as disruption of the tunica albuginea with rupture of the corpus cavernosum. This most commonly occurs during sexual intercourse, when the erect penis slips out and strikes the perineum or pubic bone, resulting in a buckle injury. It may also occur due to forced flexion of the penis, most commonly in the Middle East due to the practice of taqaandan, where the erect penis is bent forcibly to achieve rapid detumescence. Other etiologies include masturbation and rolling over onto the erect penis.

The classic presentation of penile fracture is a patient with a history of blunt trauma to the penis followed by an audible "pop" or "snap," accompanied by pain, swelling, discoloration, and rapid detumescence.

Physical examination will almost always reveal a hematoma. If Buck's fascia is intact, a local hematoma can accumulate, resulting in an "eggplant deformity." If Buck's fascia is disrupted, the hematoma can extend into the scrotum, perineum, or suprapubic regions. The penis may deviate to one side. Patients with concomitant urethral injuries may present with gross hematuria, blood at the urethral meatus, or inability to void.

A defect in the tunica albuginea may be palpated along the shaft of the penis, which is known as the "rolling sign."

Penile fracture is a clinical diagnosis based on the typical history and physical examination; however, if these are equivocal, penile ultrasound or MRI can be helpful.

Suspected penile fracture should be managed with prompt urologic referral and urgent surgical repair. Urethroscopy or retrograde urethrogram should be considered to evaluate for concomitant urethral injury and is required in patients with gross hematuria, blood at the urethral meatus, or inability to void.

While injuries to the genital region are seldom life-threatening, it is crucial to promptly diagnose and assess them to reduce the risk of potential long-term health complications.