Management of Penile Swelling

Immediate Assessment and Emergency Conditions

The American Urological Association recommends suspecting penile fracture if the patient reports penile ecchymosis, swelling, a cracking or snapping sound during intercourse or manipulation, and immediate detumescence 1, 2
Prompt surgical exploration and repair is required for penile fracture to prevent long-term complications including erectile dysfunction 1, 2
The American Urological Association recommends evaluating for concomitant urethral injury if blood is present at the urethral meatus, gross hematuria, or inability to void 1, 2
Ischemic priapism presents with completely rigid corpora cavernosa and is a medical emergency requiring immediate intracavernous treatment 3, 4
Non-ischemic priapism presents with tumescent but not completely rigid corpora, is non-painful, and is NOT an emergency 4, 5, 6

The Centers for Disease Control and Prevention recommends treating sexually transmitted epididymitis with ceftriaxone 250 mg IM once PLUS doxycycline 100 mg orally twice daily for 10 days 8, 7
For enteric organisms or antibiotic allergies, ofloxacin 300 mg orally twice daily for 10 days is recommended 8, 7
Adjunctive therapy includes bed rest, scrotal elevation, and analgesics until fever and inflammation subside 8, 7
Testicular torsion must be ruled out first, especially in adolescents, as it is a surgical emergency 8, 7

The American Urological Association recommends immediate evaluation for sudden penile swelling with cracking sound and detumescence, painful rigid erection lasting >4 hours, blood at urethral meatus, inability to void, or signs of severe infection 1, 3, 2
Painless tumescent erection can be observed at home for up to 4 weeks 4, 5, 6
Avoid sexual intercourse during treatment of infectious causes until both patient and partner complete therapy and are symptom-free 8, 7
Return for evaluation if no improvement within 3 days of starting treatment for infectious causes 8, 7

Never delay surgical consultation for suspected penile fracture, as conservative management leads to worse long-term erectile function outcomes 1, 2
Do not treat ischemic priapism with systemic therapy alone in patients with sickle cell disease or hematologic disorders, as intracavernous treatment must be provided concurrently 3
Do not confuse non-ischemic priapism with ischemic priapism, as the former is not an emergency and does not require urgent intervention 4, 5, 6
Always rule out testicular torsion in patients presenting with testicular/scrotal swelling and pain, especially in younger patients 8, 7