Postoperative Management After Penile Fracture Surgery: Intra-operative Drainage Does Not Reduce Early Morbidity After Penile Fracture Repair (FRACT AFUF project)

Purpose: Penile fracture is a rare urological emergency treated by surgical exploration. However, the indication for intra-operative drainage remains debated due to limited evidence. This study aimed to assess the impact of drainage on postoperative complications and symptoms after penile fracture repair. Methods: We performed a retrospective multicenter study including all patients who underwent surgery for clinically suspected penile fracture between 2000 and 2024 across 21 French centers. Patients were stratified according to intra-operative drain placement. The primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Operative time, hospital stay, and symptoms at 1 and 3 months were also evaluated. Multivariable logistic regression adjusted for surgical approach, urethral injury, and surgeon experience assessed associations with complications. Results: Among 519 patients, 158 (30%) received a drain. Drain placement was associated with longer operative time and hospital stay and more frequent degloving approach. The overall postoperative complication rate was 10%. Drain placement was not significantly associated with complications (OR 1.19, 95% CI 0.62–2.22; p = 0.59), whereas urethral injury was (OR 2.03; p = 0.04). At 1 month, 60% of patients reported at least one symptom; sexual pain was more frequent in the drain group (36% vs 23%; p = 0.04) but not at 3 months. Conclusion: Intra-operative drainage did not reduce early morbidity and was linked to longer operative time, hospital stay, and more sexual pain at 1 month. Drain use should therefore remain selective and tailored to intra-operative findings.