Many authors note a significant frequency of fracture of cavernous bodies related to forced maneuvers of an erect penis in Maghreb and Eastern countries [1-3], however, it is no less in case of interrupted coitus [4], such as the case of our series. The latter can be explained by the fact that our study population was so young with an average age of 35.99 years and the majority of whom were married, therefore in full sexual activity. The doggy position was the most predominant of the mechanisms in case of interrupted coitus followed by the Andromachus; our results corroborate those of some authors [5-6]. This is explained on the one hand when the man is in a dominant position and very excited, sexual intercourse can become extremely vigorous, triggering a greater impact at the moment when the penis slides out of the vagina and hits against the perineum or pubic symphysis. On the other hand when the woman is on the man and then inadvertently lands all her weight on the erect penis if it slips out of the vagina.

Although it is recognized that clinical history and genital examination are the mainstays of diagnosis, there is no consensus on how to exclude a concomitant urethral lesion, which can be present in almost a third of cases. Most authors agree that urethral catheterization should be avoided when a urethral injury is suspected and a suprapubic catheter should be inserted for drainage [7-8]. No correlation was noted between sexual position and penile injury severity in our study, as is the case in a meta-analysis in which no impact of relative risk was objectified [9].

The diagnosis of penile fracture was essentially clinical, based on the stereotypical history of the accident and physical examination. No paraclinical examination is required for diagnosis in typical forms [10-12]. However, in frustrated or late-sighted forms some authors recommend Color Doppler ultrasound, retrograde urethrocystography, cavernography, or magnetic resonance imaging (MRI) [11-13]. Retrograde urethrocystography finds its only indication in the rupture of the associated urethra. MRI makes a precise lesion assessment on the location and extent of the rupture of the albuginea of the cavernous body as well as the associated lesions such as a rupture of the spongy body or urethra [14]. Its disadvantage is related to its cost and availability. Doppler ultrasound is a non-invasive examination, less expensive than MRI, reliable when performed by experienced hands, which can highlight the rupture of the albuginea and hematoma even under albuginea [11,15-16]. In our case,­we have not used any of these examinations because of their unavailability as a matter of urgency.

The coronal approach was the most used in our study, it is the preferred route because it allows better exposure and exploration, it is the gold standard in case of bilateral lesion or complete urethral involvement [17-18].

However, several authors report the risk of edema, infection, and skin necrosis during the coronal approach of penis fracture [19]. We have not had any cases of infection or edema of the penis, this can be administered to all our patients of antioedematous. Some authors state that the lateral and longitudinal incision in front of one of the cavernous bodies allows an elective approach to the focus of fracture without skin risk but sometimes at the cost of an unsightly scar [4].

We noted a short- and long-term complication rate of 18.71% in our study with a predominance of discomfort during sexual intercourse and erectile dysfunction, similar to those of many authors [20]. This frequency in our series can be explained by the non-respect of the required period of abstinence in post-operative in some because we note a correlation between the time of abstinence and the occurrence of complications (P<0.05). The erectile dysfunction observed after penile fracture appears to be more related to a venous cause (leakage of venous blood into the spongy body) than to an arterial cause due to cavernous artery failure [21-23].

The origin of this dysfunction in our series was not known, because we have not resorted to echo-Doppler in the search for etiology. However Rajkumar, in a series of 18 cases of penis fractures, had objectified to Doppler an insufficiency of the cavernous artery in one of the patients who had erectile dysfunction after a follow-up of 3 months [22]. In our series, we have highlighted a correlation between the length of the fracture line and the occurrence of short- and long-term complications (P<0.05). We think that the size of the fracture line would be at the origin of huge fibrosis of the albuginea therefore source of stretch curvature and on the other hand of significant leakage of cavernous venous blood in the spongy, the cause of erectile dysfunction. The subjectivity of questionnaire responses is also a bias in the assessment of sexual function in our patients.