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Isolated Penile Injury in Boys: Accident, Negligence, or Abuse?
Nitin Pant1, Sudhir Singh1, Anand Pandey1
1Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
Insights
Penile trauma in boys, often caused by hair tourniquets, requires prompt medical attention. Early intervention and tailored surgical approaches are key to successful outcomes in managing these injuries.
Area of Science:
- Pediatric Surgery
- Urology
- Trauma Management
Background:
- Isolated penile trauma (PI) in children presents unique challenges in diagnosis and management.
- Understanding the common etiologies and injury patterns is crucial for effective treatment.
Purpose of the Study:
- To investigate the causes, clinical presentations, and treatment strategies for isolated penile trauma in pediatric patients.
- To evaluate the outcomes of various surgical interventions for penile injuries in boys.
Main Methods:
- A retrospective analysis was conducted on boys treated for isolated penile trauma between 2015 and 2019.
- Data collected included injury etiology, severity, management approaches, and complications.
Main Results:
- Nine cases of penile trauma were identified, with penile hair tourniquets being the most common cause (n=5).
- Injuries ranged from urethral transection and glans loss to total penile amputation and severe burns.
- Surgical management varied, including urethral anastomoses, flap phalloplasty, and staged urethroplasty, with complications such as infections and fistulas observed.
Conclusions:
- Isolated penile trauma in boys is a significant concern, with many cases being preventable through parental awareness.
- Vigilance for potential child maltreatment is essential in cases of penile injury.
- A staged, individualized surgical approach can lead to satisfactory outcomes in managing complex penile trauma.
Aim:
The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys.
Methods:
A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital.
Results:
Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end-end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1).
Conclusion:
Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.
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