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Blunt, penetrating and ischemic injuries to the penis
Jack H Mydlo1, Constantine F Harris, Jeffrey G Brown
1Department of Urology, Temple University Hospital, Philadelphia, Pennsylvania, USA.
Purpose:
We describe our experience with treating a series of 40 penile injuries, including 2 gunshot wounds, 1 stab wound, 1 zipper injury and 34 penile fractures, of which 29 were corrected surgically and 5 were managed conservatively, as well as 2 cases of glandular gangrene at 3 large inner city medical centers in a 12-year period. We describe our standard diagnostic and therapeutic modalities, which have evolved with time.
Materials And Methods:
Between 1989 and 2000, 34 patients were evaluated after blunt trauma to the erect penis resulted in penile fracture. Four patients had penetrating trauma to a flaccid penis and 2 had localized penile gangrene. Of the patients with blunt trauma 32 were injured during sexual intercourse and 2 were injured during masturbation. A single gunshot wound occurred during a crime, 2 penetrating traumas were intentionally inflicted and the remaining penetrating injury was due to a zipper. The 2 patients with penile gangrene had diabetes and were on dialysis.
Results:
A total of 32 patients were treated with surgery using a degloving incision. The corpora and urethra were evaluated with radiography or injection of saline intraoperatively. Five patients were treated conservatively for presumed penile fracture after they refused diagnostic confirmation and/or surgery, and the 2 with localized glandular gangrene were also treated conservatively. At followup 35 of the 40 patients available reported erection adequate for intercourse without erectile or voiding dysfunction. Two patients had mild curvature.
Conclusions:
In our experience a degloving procedure provided the best exposure for blunt and penetrating trauma. All penetrating injuries were débrided before repair. Saline injection showed additional corporeal body and/or urethral pathology, and also assessed the integrity of repair. Distal amputation in patients with localized glandular gangrene may result in sloughing and further complications. However, hyperbaric oxygen and local wound care may be adequate if there is no progression of gangrene.