Suspected penile fracture: to operate or not to operate?

Distinguishing penile ecchymosis from a true penile fracture, or a rupture through the tunical albuginea, can be a challenging clinical conundrum. A penile fracture typically occurs in the setting of blunt penile trauma to the erect penis, most often during sexual intercourse or masturbation. The characteristic symptoms of penile fracture are a “snapping” or “popping” sound, penile pain, and immediate detumescence followed by ecchymosis and swelling of the penile shaft (1).