Open injuries to the penis

Open injuries to the penis occur as a result of the impact of wounding objects (gunshots, cuts, stab wounds) and animal bites (horses, dogs, cows, etc.). Injuries from piercing and cutting objects that penetrate the thickness of the cavernous bodies are often accompanied by complete or partial amputation of the organ and are considered severe injuries to the penis.

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Causes open penile trauma

Most injuries are accompanied by damage to the hanging part of the urethra. If the circumcision operation is technically performed incorrectly, iatrogenic injuries to the penis are also possible. The literature has repeatedly described amputation of the penis during circumcision of the foreskin during religious rituals.

Superficial wounds of the penis

Superficial wounds of the penis that do not reach the protein membrane are accompanied by minor bleeding. The leading cause of penile trauma is excessive friction. Such problems most often occur in passionate lovers and men who are just starting their sexual life. The former are characterized by relatively deep skin damage, which leaves scars.

For the latter, damage to the frenulum of the foreskin is typical. Frequently, injuries to the frenulum of the penis (ruptures or tears) occur during intense sexual intercourse and/or in the presence of a congenital short frenulum of the penis, accompanied by pain and significant bleeding, which can be stopped by surgical intervention - suturing the wound or using electrocoagulation. Frenuloplasty and circumcision are often performed at the same time.

When the penis is injured by piercing and cutting objects of rotary mechanisms, machines or other instruments, extensive wounds of the skin of this organ occur, sometimes with significant defects not only of the skin, but also of the cavernous bodies with significant circulatory disorders, leading to necrosis.

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Penis bites

Penile bites may be the result of hostility from domestic animals or deliberate actions by sexual partners. Such wounds are characterized by a small area of tissue damage, minor bleeding, and poor regenerative capacity.

Moreover, such injuries are almost always infected; in 50% of cases of dog bites, wounds are infected with Pasteurella multocida in combination with other microorganisms (Escherichia coli, Aerococcus viridans, Bacteroides spp., etc.).

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Thermal injuries of the penis

These include acid burns, alkali burns, thermal burns and frostbite of the penis, which occur as a result of exposure of the body to high and low temperatures. Isolated frostbite of the penis is also possible, which can occur in a man who is not dressed warmly enough and who walks for a long time towards a cold wind.

Burns of the penis occur when exposed to hot liquids and objects, chemically active substances, sun and X-rays, radioactive isotopes. With a superficial burn of the first degree, redness and swelling of the tissues of the penis are noted. With a deeper burn (second degree), blisters form on the skin, the tissue is edematous. This can lead to urinary retention. With a third degree burn, skin necrosis occurs, and with the fourth degree, not only the skin dies, but also the spongy bodies.

In most cases of frostbite of the penis, the foreskin is affected, but frostbite of the body of the penis is also possible. Immediately after frostbite, the skin of the affected area turns purple-blue, itching, burning, stabbing pain, impaired sensitivity (paresthesia), and swelling appear. After a few days, these symptoms disappear. With deeper damage, ulcers with purulent discharge appear on necrotic areas of the skin, which heal within 3 months.

Diagnostics open penile trauma

When collecting anamnesis, it is necessary to collect complete information about the characteristics of the factor leading to damage to the penis and the circumstances of the injury. In addition to the general principles of treating injuries, it is necessary to remember that in case of injuries to the external genitalia, it is often necessary to pay attention to the intimate side of the issue.

The diagnosis of open injuries of the penis is based on the anamnesis, examination (location, nature of the wound, direction of the wound channel, presence of an exit hole), palpation (defects in the cavernous body, foreign body), ultrasound and plain radiography (to determine the presence and location of foreign bodies). Recognizing an open wound of the penis, as a rule, is not difficult. The nature of the injury is established after stopping the bleeding and revising the wound.

Intensive bleeding from a wound to the cavernous bodies of the penis continues in the first hours after the wound. Hematomas form 0.5-2 hours after the wound, and the bleeding stops. Blood, imbibing the subcutaneous tissue, blocks the lymphatic pathways and often causes significant swelling of the penis.

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Treatment open penile trauma

In case of combined wounds of the penis, simultaneously with measures aimed at stopping bleeding and bringing the wounded out of shock, it is necessary to perform the most gentle surgical treatment of the wound of the penis with excision of necrotic tissues in order to prevent cicatricial deformation of the organ in the future. When treating a wound of the penis, it is necessary to remove foreign bodies that can subsequently cause pain during erection. For this purpose, the wounded are shown to undergo an X-ray examination. When treating wounds of the penis, the urologist must take into account that even significantly injured and blood-imbued tissues can restore their viability after several days.

During surgery, manipulations on the cavernous bodies should be gentle, as they can expand the area of damage: they should be carried out after determining the necrosis zone. Sparing excision of damaged tissues at the stages of providing qualified medical care reduces the need for skin plastic surgery to 1.6%. In 1.2% of cases, crushing of the penis is observed, requiring amputation of the organ.

Treatment of open injuries of the penis at the prehospital stage begins with the application of a protective aseptic, and if necessary, pressure, bandage on the penis and, if possible, a tourniquet. Antibacterial therapy begins, painkillers and tetanus toxoid are administered. When treating infected wounds of the penis, the drugs of choice are cephalosporins and macrolides (erythromycin).

Surgical treatment includes primary surgical treatment of the wound, final stopping of bleeding, and drainage of urine from the bladder. In case of partial detachment of the penis, primary surgical treatment of the wound is performed with economical excision of tissue and restoration of parts of the damaged organ. Amputation and excision of the skin of the penis are possible only in case of necrosis. Plastic surgery to replace skin defects and surgery to restore the penis are performed in a specialized department.

In case of complete traumatic amputation of the penis, the severed organ must be preserved, since it can be sewn into the stump within the first 18-24 hours after the injury. To preserve the viability of the amputated organ, it is washed with a povidone-iodine solution, packed in a sterile bag filled with a sodium lactate complex solution (Ringer's Lactate Viaflo solution), and stored on ice until surgery. In case of amputation of the penis, plastic surgery to restore the penis (phalloplasty) is often required. The amputated part of the penis is replaced with a Filatov stem, which is cut out of the skin of the abdomen and thighs. To give the neophallus functional rigidity, phalloprostheses of various designs are implanted into the skin stem.

Due to the abundant blood supply and high regenerative capacity of the tissues of the penis, the treatment tactics should be maximally organ-preserving. In all cases of almost complete amputation of the penis, suturing of its ends is mandatory. It should be taken into account that even significantly injured and blood-imbued skin flaps can restore their viability in a few days. To ensure the wound is at rest, the patient is prescribed drugs that prevent erection.

In case of extensive wound defects of the skin and scalp wounds of the penis, the missing areas of skin are replaced by skin grafting. In wounded patients with preserved foreskin, plastic surgery is performed according to the Dittel method. The operation consists of separating the outer layer of the foreskin from the inner one, and the skin flap, thus doubled in size, is pulled over the wound surface and fixed to the edges of the remaining skin.

In the case of complete absence of penile skin, plastic surgery using the Reich method is used - replacing the defect with scrotal skin. For this purpose, two horizontal incisions are made at the root and bottom of the scrotum at a distance from each other corresponding to the wound surface on the penis. The skin between the incisions is peeled off, and the penis is placed in the wound tunnel thus formed. Sutures are placed between the remaining skin at the head and root of the penis and the lower and upper edges of the skin bridge of the scrotum. After 2-3 weeks, the formed skin bridge is crossed alternately or immediately on both sides by incisions parallel to the penis and its edges are sutured on the back surface of the penis. The scrotal wound is sutured.

In cases where it is not possible to use the scrotum skin for penile plastic surgery, the skin defect of the penis is compensated for with a bridge flap from the skin of the pubic area and lower half of the abdomen (Bessel-Hagen method) or the inner surface of the thighs (L.B. Zagorodny method). Plastic surgery of penile skin defects can also be performed with free skin flaps.

If the integrity of the tunica albuginea is damaged, knotted catgut sutures are applied to it in the transverse direction to the axis of the penis, avoiding suturing large vessels, which prevents the cells of the cavernous bodies from becoming empty. In this case, one should try not to deform the cavernous body. If one cavernous body is injured with its complete rupture, the ends of the cavernous body are brought together and its integrity is restored with catgut sutures, capturing the tissue of the cavernous body and the tunica albuginea in the suture. The same procedure is used if both cavernous bodies are damaged.

In case of simultaneous damage to the urethra, a suprapubic vesical fistula is created.

In cases of crushing of the peripheral part of the penis, when tissue necrosis is clearly visible, amputation of this part of the penis is performed. Amputation in case of destruction of both cavernous bodies is performed only after establishing the demarcation line of gangrene. Subsequently, such patients are shown reconstruction of the penis. Surgical treatment of thermal lesions of the penis is carried out according to general principles; it is aimed at removing necrotic tissue, replacing defects of the skin and cavernous bodies, restoring penile function. In case of pronounced changes localized in the area of the foreskin, circumcision is performed.