Penile fracture, also known as rupture of the penile tunica albuginea and corpus cavernosum or penile fracture, is one of the closed penile injuries, and moreover, it is one of the urological emergencies in urological injury patients, which is rare in clinic. Some patients are shy to consult the doctor when the penile injury is mild or consult the doctor in irregular hospitals, resulting in adverse consequences such as penile fibrous scar formation, hardness, erection pain, and sexual insufficiency. Now, we analyze the case data of 13 patients diagnosed with penile fracture in our hospital from 2008.1 to 2011.8, and summarize the clinical diagnosis and treatment experience of penile diagnosis, with a view to improving the diagnosis and treatment level of penile fracture disease. 1. Materials and methods 1.1 Clinical data The 13 cases in this group were aged 15-61 years old, with an average age of 37.5 years old. Married 12 cases, unmarried 1 case. Time from injury to consultation 0.5～20 hours. Causes of injury: 6 cases of rough sexual intercourse, 5 cases of masturbation, 2 cases of falling down and hitting hard objects after drunkenness, 2 cases of combined urethral cavernous body injury. 13 cases heard different degrees of sound like balloon rupture, accompanied by pain, penile erection immediately subsided, penile weakness, accompanied by the formation of penile subcutaneous hematoma. The distal penis to one side, subcutaneous hemorrhage severe 1 case of penile torsion obvious, buried penis head, not obvious to which side, surgical confirmation of both sides of the penile corpus cavernosum fracture combined with urethral corpus cavernosum fracture; 1 case of surgical confirmation of simple urethral corpus cavernosum rupture did not injure the urethra; the rest of the 10 cases of the left side of the corpus cavernosum rupture of 4 cases, 6 cases of the right spongiosum fracture. In the remaining 10 cases, 4 cases of left cavernous body rupture and 6 cases of right cavernous body rupture were found. 12 cases of rupture were located in the anterior 2/3 of the corpus cavernosum of the penis, and 1 case was found at the angle of the penis. 13 cases of rupture were transverse rupture, with the length of rupture ranging from 0.2cm to 1.5cm, and the depth of rupture ranging from 0.2cm to 0.8cm. 1.2 Diagnostic and therapeutic methods All 13 cases were diagnosed according to the clinical manifestations, and no special examination was performed. Under lumbar and rigid anesthesia, 2 cases of hematoma were not obvious, the penis was curved to the healthy side, and the fissure could be obviously touched, after combining the patient’s complaints about the cause of the injury, a local longitudinal incision was made, the fissure was directly exposed, and the fissure of the cavernous body of the penis was interruptedly closed with a 3-0 Vybridge suture; the rest of the 11 cases were all treated with a ring-type incision of 1cm away from the coronal sulcus, and the sheath of the skin and the stem of the penis were separated from the penis and pushed to the root of the penis in 10 cases, to explore the rupture of the penis. The root of the penis was explored for the location of rupture, and after exposing the fissure, the penile corpus cavernosum fissure was closed intermittently with 3-0 Vybridge suture. For patients who did not urinate and had hematuria after the injury, after anesthesia, a urinary catheter was left in place, and one case was confirmed to be a rupture of the urethral spongiosum, while the rest had no obvious rupture of the urethra. At the end of the operation, a urethral catheter was left in place, and the penile urethral spongiosum, penile tunica albuginea and Buck’s fascia were closed intermittently with 3-0 Vicryl sutures, and all the patients had their clots removed during the operation, and the outer layer of the elastic bandage was appropriately compressed and bandaged to keep the urethral catheter in place. 1 case of combined urethral rupture retained the urethral catheter for 14 days, and the rest of the patients retained the catheter for 4-6 days. Postoperatively, broad-spectrum antibiotics were used to fight infection, and estrogens such as ethinyl estradiol were not used to inhibit erection. 2. Results All patients were discharged from the hospital in 5-7 days, and one patient with combined urethral rupture had no difficulty in urination or urinary fistula when the catheter was removed after 14 days, and no urethral stenosis was observed in 6 months of follow-up. All of the patients had a favorable outcome without complications such as penile deformity, painful hardness, erectile dysfunction and decreased quality of sexual life, and there were no cases of re-fracture. 3, DISCUSSION Penile fracture is a direct external force on the penis in the erectile state, resulting in rupture of the tunica albuginea and the corpus cavernosum of the penis [1]. Most of the cases occurred during rough sexual intercourse or masturbation when the penis was severely curved by forceful squeezing, or when rubbing with hard objects, and also occurred when the penis was hit during erection. During sexual intercourse, most penile breaks occur when the penis collides with the woman’s pubic bone or perineum, hits the bedpan when coming out of the vagina, or when changing positions. When the penis is erect, the thickness of the tunica albuginea is about 1/4~1/2mm, inelastic, and significantly thinner than the 2mm in the non-erect state. When fracture occurs, the patient usually hears a “bang” sound, followed by penile weakness and pain. When the penis is fractured, the rupture of the tunica albuginea and the rupture of the corpus cavernosum of the penis usually occur at the same time, and the bleeding is obvious, and when the patient visits the doctor, there is often a serious subcutaneous hematoma of the penis, and the skin of the penis is generally blue-purple.When Buck’s fascia has not been ruptured, usually the hematoma is confined to the penis, and it will not spread to the perineum. If combined with urethral injury, there may be difficulty in urination, pain in urination, blood dripping from the urethra and so on. Clinical diagnosis can be made according to the symptoms and signs, ultrasonography is a direct and effective diagnostic method for penile fracture, which has the advantages of high accuracy, simplicity, rapidity and painlessness. Spongiography and penile MRI can be used as a diagnostic method, but they are time-consuming, costly, and have many side effects, so they are not routinely examined. There are two kinds of treatment: non-surgical treatment and surgical treatment, but non-surgical treatment often has serious complications and affects sexual life. At present, most advocate emergency surgical exploration, penile fracture repair surgery, in order to remove hematoma, repair the ruptured white membrane, restore the continuity of the cavernous body, and maximize the avoidance of infection, fibrous scarring, and the formation of penile deformity. The circumferential decortication incision on the coronal groove can better expose the penis and urethral cavernous body, which facilitates the finding of the site of trauma and the bleeding point. Some scholars also advocate the use of ventral midline incision [5], for the hematoma is not obvious, the site of injury is clear cases can be feasible local longitudinal incision, direct exposure of leukomalacia fissure for repair. This group of 13 patients were injured when they heard varying degrees like the sound of balloon rupture, accompanied by pain, penile erection then subsided, penile weakness, accompanied by penile subcutaneous hematoma formation. The reason for the fracture, 6 cases of fracture during sexual intercourse, 5 cases of masturbation, 2 cases of falling and hitting hard objects after drunkenness. The diagnosis was made according to the symptoms and signs, without ultrasound and other examinations, and the treatment was surgical exploration and repair, with satisfactory surgical results and good prognosis. All patients in our hospital did not use estrogen to inhibit erection after surgery, and married patients resumed sexual life normally two months after surgery, with no decrease in the quality of sexual life, and none of them suffered re-fracture. Therefore, we believe that a clear diagnosis can be made on the basis of typical clinical symptoms and signs, and emergency surgical exploration and repair can achieve good therapeutic results. Without the use of estrogen to inhibit penile erection, a good prognosis can be achieved.