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Gunshot wounds to the male external genitalia
R G Gomez1, A C Castanheira, J W McAninch
1Department of Urology, University of California School of Medicine, San Francisco.
Abstract:
We report on 23 patients with genital gunshot wounds treated since 1977. Of these 23 patients 16 received 1 shot and 7 received multiple shots. The bullet affected the scrotum in 12 patients, the penis in 4, and the penis and scrotum in the remaining 7. The same missile also compromised the thigh in 15 patients, with major vascular damage in 2. Management was based on serial clinical evaluation and aggressive imaging, related to the missile trajectory. Staging studies were 100% accurate in the patients in whom they were done. Nine patients had damage to the testis (7, 1 bilaterally) and/or spermatic cord (2): 5 required orchiectomy, in 3 the testis was repaired and in 2 the bullet transected the vas, which was ligated with nonabsorbable suture for later repair. Six patients had damage to the corpora, which were repaired. Three patients had urethral rupture (bulbar in 2 and penile in 1): primary repair was feasible in 2 and in 1 (with extensive urethral loss after a shotgun blast) a suprapubic tube was placed for delayed reconstruction. Ten patients had skin penetration only, 5 of whom were managed nonoperatively. There were no major complications or mortality. Also, there were no delayed problems in the nonoperated patients. Erection and normal voiding were reportedly present in all who underwent reconstruction and returned for followup. Early surgical exploration with conservative debridement and primary repair of damaged structures is the preferred treatment for these injuries.
Insights
Genital gunshot wounds in 23 patients were treated with early surgical exploration and repair. Most injuries involved the scrotum and penis, with successful functional outcomes reported after reconstruction.
Area of Science:
- Urology
- Trauma Surgery
- Forensic Medicine
Background:
- Genital gunshot wounds are rare but can lead to significant morbidity.
- Management strategies have evolved, emphasizing timely intervention.
Purpose of the Study:
- To review the management and outcomes of genital gunshot wounds.
- To evaluate the effectiveness of early surgical exploration and repair.
Main Methods:
- Retrospective review of 23 patients with genital gunshot wounds treated since 1977.
- Management included clinical evaluation, imaging, and surgical repair.
- Outcomes assessed included functional recovery (erection, voiding) and complications.
Main Results:
- 16 patients had single shots, 7 had multiple shots.
- Injuries affected the scrotum (12), penis (4), or both (7).
- Testicular/spermatic cord damage occurred in 9 patients, requiring orchiectomy in 5.
- Penile/corporal damage in 6, urethral rupture in 3.
- No major complications or mortality; all reconstructed patients reported normal function.
Conclusions:
- Early surgical exploration, debridement, and primary repair are preferred for genital gunshot wounds.
- Conservative, nonoperative management is suitable for superficial injuries.
- Reconstruction leads to favorable functional outcomes.