Trauma: External Genitalia Trauma

Penile Trauma

AAST Penis Injury Scale

Penile Fracture

  • Fracture Results in a Tear of the Tunica Albuginea
  • Rare Due to General Mobility
    • Blunt Injury Usually Only of Concern When Penis is Erect
  • Causes:
    • Vigorous Sexual Intercourse – Most Common
    • Masturbation
    • Taqaandan (Penile Cracking) – Middle East Practice of Self-Inflicted Forcible Bending to Deflate an Unwanted Erection
  • Often Hear an Audible “Crack” or “Pop” with Rapid Detumescence
  • Risk for Urethral Injury (20%) – Consider Retrograde Urethrogram or Intraoperative Cystoscopy
  • Dx: History & Physical Exam
    • If Equivocal: US
  • Tx: Prompt Surgical Exploration (Repair Tunica Defect)

Penetrating Penile Wound

  • Most Common Cause: Gun Shot Wounds
  • High Risk for Urethral Injury (15-50%) – Consider Retrograde Urethrogram
  • Tx: Immediate Surgical Exploration, Washout & Primary Closure
    • *Generally Avoid Urethroplasty with Buccal Grafting or Flaps in Trauma – It is Generally the Preferred Treatment Chronic Urethral Strictures

Penile Amputation

  • Most Commonly from Self-Mutilation with High Risk of Psychosis
  • Tx: Microscopic Replantation if Available

Penile Fracture 1

Penile Amputation 2

Testicular Trauma

AAST Scrotum Injury Scale

AAST Testis Injury Scale

Testicular Fracture/Rupture

  • Fracture Results in a Rupture of the Tunica Albuginea
  • Most Common in Blunt Trauma (75%)
  • Dx: History & Physical Exam
    • If Equivocal: US
  • Tx: Prompt Surgical Exploration (Repair Tunica Defect)

Penetrating Scrotal Wound

  • Frequently (80%) Also Have Injury to Other Surrounding Structures
  • Tx: Immediate Surgical Exploration & Repair

Testicular Torsion

Testicular Rupture US 3

Testicular Torsion 4

References

  1. Bali RS, Rashid A, Mushtaque M, Nabi S, Thakur SA, Bhat RA. Penile fracture: experience from a third world country. Adv Urol. 2013;2013:708362. (License: CC BY-3.0)
  2. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, Buckley JC. Surgical management of traumatic penile amputation: a case report and review of the world literature. Sex Med. 2015 Mar;3(1):49-53. (License: CC BY-NC-4.0)
  3. Rao MS, Arjun K. Sonography of scrotal trauma. Indian J Radiol Imaging. 2012 Oct;22(4):293-7. (License: CC BY-NC-SA-3.0)
  4. Tang YH, Yeung VH, Chu PS, Man CW. A 55-Year-Old Man with Right Testicular Pain: Too Old for Torsion? Urol Case Rep. 2017 Feb 7;11:74-75. (License: CC BY-NC-ND-4.0)