Penile injuries
From Medical-Wiki
The list of possible injuries to the penis include fracture, amputation, penetrating penile injuries, and penile soft tissue injuries. They are all considered to be urologic emergencies. They typically require surgical intervention.
In circumcised males, penile fracture can occur when the penis slips out of the vagina and strikes the perineum or the pubic symphysis. However, any other trauma to an erect penis can result in the same condition. Patients will often describe having heard a popping or snapping sound, immediately followed by detumescence. Pain associated with the fracture varies from slight to severe.
Physical examination reveals what has been called an “eggplant” deformity. The penis is exceedingly swollen with large amounts of ecchymosis. There may often be an S shaped deformity of the penile body with deviation away from the side of the tear because of the effect of a large hematoma. Damage to the urethra may appear as blood at the meatus.
Rupture of the deep dorsal vein of the penis can be confused with a penile fracture. A deep vein rupture should be surgically explored to rule out an accompanying fracture.
Surgical therapy for penile fracture results in significantly fewer complications than conservative management. One recent report sites a 92% success rate for surgical repair as opposed to a 59% success rate for medical treatment. The surgical procedure attempts to evacuate the hematoma, identify the injury, repair the tunica albuginea, and if present repair any urethral damage. [1]
Penile amputation has been called a catastrophic event. That is self evident. It is usually either self-inflicted or as result of an assault. If possible, the amputated member should be preserved in saline-soaked gauze inside a clean bag. This bag should be sealed and placed in another bag that is filled with ice slush. Replantation of a cooled member may successfully take place up to 24 hours after the amputation. At room temperature, the outside time limit is probably 15 hours.
Both microvascular repair and conventional reattachment can be successful although microvascular repair is gaining favor. Experienced surgical teams have reported success in re-establishing penile shaft skin, a sensate glans, and normal orgasmic function. [2]
35% of all genital injuries are caused by gunshot wounds. Stab wounds of the penis are uncommon. The majority of these injuries are the result or wartime wounds. The need to treat penetrating wounds of the penis has increased in proportion to the survival of significant abdominal and extremity wounds because of aggressive in-field treatment and the use of effective body armor. This is exacerbated by the fact that body armor does not cover genitals.
Obviously, any life-threatening injuries must be attended to prior to giving attention to penetrating wounds of the penis. The penis is actually somewhat resistant to these wounds because it is mobile and somewhat protected by the mass of the pelvic bone. Usually, penetrating wounds are reasonably obvious to simple inspection, but it has become increasingly common for trauma teams to do retrograde urethrography to evaluate for urethral injury.
The most common soft-tissue injury of the penis is avulsion. This is true because the overlying penile skin is loose and elastic, lending it to a predisposition for being easily ripped from the penile body.
One soft tissue injury that can be devastating is a bite injury, not only because the very thought of such is nauseating but also because it often is not attended to for some time secondary to embarrassment. This leads to a high incidence of infection and abscess formation. These can then extend into necrotizing fasciitis of the scrotum, a potentially fatal complication. [3]
