Penile fracture is an uncommon but serious urological emergency characterized by the rupture of the tunica albuginea of the corpus cavernosum following blunt trauma to an erect penis [1] [2] . Typically resulting from sexual intercourse, masturbation, or forceful manipulation, penile fracture necessitates prompt surgical intervention to prevent long-term complications such as erectile dysfunction, penile curvature, and urethral injuries [3] [4] . Globally, the incidence and mechanisms vary geographically due to differences in sexual practices and cultural behaviors [5] [6] and the timing of surgical intervention for penile fracture is heavily influenced by socio-cultural and systemic factors. In countries like Brazil, early presentation is common, with most patients seeking care within 24 hours, resulting in better functional outcomes [7] . However, in North Africa, delayed consultation is more frequent due to embarrassment, stigma, and cultural taboos around sexual injuries. Studies from Morocco show that such delays increase complications, including erectile dysfunction and penile curvature, even when surgery is performed [8] [9] . Forced penile manipulation, often practiced to suppress unwanted erections due to cultural norms, is a leading cause of injury in these regions [9] . These findings mirror trends in sub-Saharan Africa, where similar socio-cultural barriers and limited access to specialized care led to poor outcomes [3] [10] . Addressing these delays requires not only surgical preparedness but also public education and culturally sensitive awareness campaigns.

Studies from Africa suggested that delays in presentation and in treatment are common due to embarrassment, limited access to specialized urological care, and cultural factors [3] [11] . In Nigeria, delayed presentations have been shown to affect outcomes significantly [10] . Similarly, hidden or atypical presentations complicate diagnosis and delay treatment initiation [12] . Early surgical repair has been associated with better outcomes, whereas conservative management and late intervention are linked to higher rates of erectile dysfunction and penile deformity [13] .

Despite an increasing number of reports globally, including Africa, there is a paucity of comprehensive local data from Cameroon. Particularly, there is limited evaluation of how the timing of surgical intervention influences erectile function and clinical recovery. This gap is significant as the early versus delayed intervention debate has major implications for treatment protocols, patient counseling, and resource allocation [1] [11] . Hence, this study was undertaken to assess the impact of time to surgery on erectile function and clinical outcomes among penile fracture patients managed at two major hospitals in Bamenda, Cameroon.

The objectives were to determine the relationship between time to surgical repair and postoperative erectile function, to evaluate other clinical outcomes such as penile curvature, urinary complications, time to resumption of sexual activities, and to compare our findings with those reported globally.

Ethical approval was granted by the IRB of Cameroon Baptist Convention Health Services (IRB2024-25 of January 12, 2025) and administrative authorization from both hospitals. Informed consent was obtained. The study followed the Declaration of Helsinki principles.

The results of our study reinforce the critical importance of early surgical intervention in penile fracture cases, showing clear benefits in erectile function preservation, reduced complication rates, and faster sexual recovery. These findings are in line with prior studies across sub-Saharan Africa and beyond. For example, Mbassi et al. (2025, Cameroon) and Odzébé et al. (2019, Congo) similarly reported significantly better functional outcomes when surgical repair was performed within 24 hours of trauma [1] [5] .

Our erectile dysfunction rate of 19.2%, entirely confined to the delayed surgery group, aligns closely with outcomes reported by Ogbetere (2022, Nigeria) and Ofoha et al. (2021, Nigeria) [3] [10] . These results validate the hypothesis that delays in surgical management lead to worsening fibrotic changes in the corpora cavernosa, which impair the penile hemodynamic response necessary for erection. In contrast, Eyongeta et al. (2018, Cameroon) reported a slightly higher rate, likely due to the inclusion of patients treated conservatively or with longer surgical delays [11] .

The mean time to resumption of sexual activity was significantly shorter in the early surgery group (9.5 weeks) compared to the delayed group (12.3 weeks), mirroring observations from Atwine et al. (2024, Uganda) [13] . This may reflect faster tissue healing, improved psychological recovery, and reduced fear of reinjury among early-treated patients. As highlighted in previous literature (Yunusa et al., 2019, Liberia; Sabharwal et al., 2015, India), delayed repair often translates to both physical and psychological sequelae, which impede sexual rehabilitation [2] [12] .

The significant association between delayed surgery and higher complication rates (χ² = 5.77, p = 0.0163) in our study confirms observations made by Ogbetere & Otobo (2021, Nigeria) and Ukpong et al. (2023, Nigeria) [3] [4] . Complications in penile fracture—ranging from urethral injury to wound infection and penile curvature—are not only more frequent with delayed care but also tend to be more severe and refractory.

Our multivariate analysis further strengthens these conclusions. Even after adjusting for postoperative complications and time to sexual resumption, delayed surgery remained a robust independent predictor of erectile dysfunction. The penalized regression model, which overcame the issue of perfect separation encountered in standard logistic regression, emphasized that delayed intervention leads to a substantial increase in ED risk. The model also indicated that presence of complications and longer delays to sexual recovery were additional independent contributors to poor erectile outcomes.

This level of statistical robustness is seldom demonstrated in penile fracture studies from the African continent, underlining the strength of our multi-center approach. Compared with studies such as Odzébé et al. (2019, Congo) and Eyongeta et al. (2018, Cameroon) and, our integration of multivariate modeling adds depth to the evidence advocating for early surgical management [5] [11] .

Furthermore, the distribution of corporal tear locations and mechanisms of injury in our study resembled those reported in West and Central Africa, where the “woman-on-top” position remains a leading cause (Ukpong et al., 2023; Odzébé et al., 2019) [4] [5] . Right-sided tears predominated, which is consistent with findings by Eyongeta et al. (2018), possibly due to right-hand dominance influencing penile manipulation and angulation during trauma [11] .

Taken together, our findings add critical local data to the growing literature advocating early penile fracture repair. While cultural taboos and limited access to specialized urology services may delay presentation, these barriers must be overcome through public awareness campaigns and clinician education. Our findings provide strong evidence-based justification for such public health interventions.

Our study offers several notable strengths. It is among the few multi-center analyses in sub-Saharan Africa evaluating the impact of surgical timing on erectile function in penile fracture patients. The inclusion of two referral hospitals improves generalizability within the region, and the standardization of surgical techniques across centers enhances internal consistency. Additionally, the use of both bivariate and multivariate statistical methods—particularly penalized logistic regression—adds depth and reliability to our findings by addressing potential confounding factors.

However, some limitations exist. The retrospective design may have introduced recall bias and missing data, especially in outcome assessment. The relatively small sample size, though one of the largest in Cameroon for this topic, limited the statistical power to detect smaller effects or conduct subgroup analysis. Moreover, pre-injury erectile function data were not objectively captured, which may have confounded post-operative erectile function assessments. Despite these constraints, the study provides valuable insights and a strong foundation for future prospective, larger-scale research.

This study demonstrates that early surgical repair of penile fracture (less than 24 hours) significantly improves erectile function outcomes, reduces complication rates, and facilitates faster return to sexual activity. The statistical association between delayed intervention and adverse outcomes was consistent across bivariate and multivariate analyses, affirming the importance of timely surgical management. Our findings are supported by regional and international literature and offer robust evidence from a sub-Saharan African context. Given the psychosocial and functional impact of penile fracture, healthcare systems should prioritize rapid diagnosis and referral to urological services. Public education campaigns and clinician training are essential to overcome barriers to early presentation. Future prospective studies with larger sample sizes and standardized pre- and post-operative assessments are warranted to build on this foundation and refine management guidelines for penile fracture.

We would like to express our profound gratitude to all the patients who graciously consented to participate in this study. Your willingness to contribute to this research is deeply appreciated and has been invaluable to the success of this project.

We are equally thankful to the Directors and administrator of Regional Hospital Bamenda and Nkwen Baptist Hospital respectively for their administrative authorization and unwavering support, which made it possible to conduct this study within their respective institutions.

Furthermore, our sincere thanks go to all the hospital staff that played a role in facilitating the study, whether through logistical support, patient coordination, or assistance in data collection. Your cooperation and dedication were vital to the smooth execution of the research.