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Penile Injury: Causes, Diagnosis and Treatment

Etiology of Penile Injury

Penetrating injury:

Penetrating injuries of the penis are caused by firearms or stabbing. Infrequent are injuries by masturbation with vacuum cleaners or other devices [fig. Severe penile injury].

Blunt penile injury:

Blunt penile injury is most often due to sports or traffic accidents. The accompanying urethral injury and testicular trauma usually contribute to the severity of the injury.

Self-injury:

Strangulation injuries occur when constricting objects such as rings or bottles are slipped over during masturbation [fig. penile strangulation]. The disturbed blood and lymphatic drainage leads to swelling, which makes removal impossible. Necrotic tissue damage is possible due to delayed presentation. Infrequent are self-inflicted incisions up to self-amputation, mainly in the context of psychotic episodes or in patients with transsexuality.

Bite injuries:

Rare, caused by animal or human bites.

Burns:

Isolated burns of the external genitalia are uncommon. Concomitant burns of the external genitalia, however, are present in 5–13% of all burns.

Penile fracture:

A penile fracture is the rupture of the corpora caverosa during erection due to bending trauma, see next section penile fracture.

Diagnosis of Penile Injury

Retrograde urethrography if urethral injury is suspected, ultrasound imaging of the testes to rule out testicular injury, and examination of the wound (under anesthesia if necessary).

Treatment of Penile Injury

Conservative Therapy:

Blunt injuries and minor skin tears can be treated without surgery: cleaning and disinfection of abrasions, cooling and elevation of the penis and scrotum, and considering antibiotics for contaminated lesions.

Principles of surgical therapy:

Surgical wound revision is necessary for gunshot wounds, stab wounds, bite wounds, and self-inflicted injuries. Superficial injuries can be treated under local anesthesia; injuries to the corpora cavernosa and urethra require general anesthesia. Avital tissue is removed, and the wound is cleaned (saline irrigation). Hemostasis and drainage of hematomas. Suture and reconstruction of urethral injuries and cavernous body injuries [fig. Severe penile injury]. If possible, primary skin closure is sought in clean wounds (Horst et al., 2004).

Burns:

Burns are mostly managed with initially conservative therapy. Necrotic skin areas are excised sparingly since the genital skin has a remarkable regenerative capacity.

Strangulation injuries:

The constricting object is cut with a small rotary tool and water cooling [fig. penile strangulation].

Amputation injury of the penis:

Reconstruction should be attempted if the amputated part is in good condition: first, suture of the corpora cavernosa and urethra, then microsurgical anastomosis of the nerves, veins, and arteries. Alternatively, hemostatic suture of the cavernous body injury and, if necessary, the creation of a perineal urethrostomy.

Infectious complications:

Perioperative antibiotic therapy is often used, especially for bite wounds and dirty penetrating injuries. Check the tetanus vaccination. In bite injuries, check the risk of sexually transmitted diseases and rabies.

References

EAU Guidelines: Urological Trauma

van der Horst, C.; Portillo, F. J. M.; Seif, C.; Groth, W. & Jünemann, K. P. Male genital injury: diagnostics and treatment.
BJU Int, 2004, 93, 927-930.

Theimuras, M. A. Penisverletzungen bei Masturbation mit Staubsaugern
Technische Universitat München, 1978.

  Deutsche Version: Penisverletzung