PENILE TRAUMA Flashcards
What percentage of patients sustaining injury to the external genitalia required RBC transfusion due to blood loss from genital injury alone.
25
Pertinent anatomy of a patient with Penile Trauma.
(1) Penis
(a) Corpus cavernosum involvement
(2) Urethra
Signs and symptoms
(1)Will be based on mechanism of injury
Differential Diagnosis
Penile rupture or fracture
(a) Blunt trauma to the erect penis may cause rupture of the corpus cavernosum
(b) Associated with
1) Immediate pain
2) Deforming hematoma (“eggplant deformity”)
3) “Cracking sound”
4) Immediate detumescence
5) May cause urethral injury
Differential Diagnosis
Self-inflicted injuries
(a) Amputation
1) Can also occur secondary to clothing being trapped by heavy machinery
(b) Vacuum injuries
1) Cause extensive injury to the glans penis and urethra.
(c) Zipper injuries
1) Trapped penile or scrotal skin in a zipper
2) Local anesthetic is injected and then on attempt may be made to unzip the zipper
after mineral oil lubrication
a) Should attempt to remove ASAP because with the increasing time of
entrapment, the tissue becomes edematous and more difficult to remove.
1 If this fails, wire cutting or bone cutting pliers are used to cut the median
bar of the zipper slider.
2 Causes the zipper to fall apart, freeing the entrapped skin.
(d) Constriction/strangulation injuries
1) Occur from objects placed circumferentially around the penile shaft.
2) Usually from constricting penile rings used to enhance erections
3) Require immediate removal to prevent urethral injury and neurovascular
compromise
4) Can also be caused by hair or string
5) Managed by removing the constricting agent
(e) Degloving injuries
1) Complete penile skin loss
(f) Penetrating injuries
1) Commonly include
a) Animal bites
b) Gunshot wounds
c) Stabbing injuries
2) Often involve urethra injuries
(g) Contusions
1) Usually treated conservatively
Treatment
a) Analgesics
1 Acetaminophen (Tylenol) - Analgesic, centrally-acting Nonopioid
medication
a Dose: 325-1000mg PO q 4-6 hours, max 4 grams/24 hours
b MOA: antipyretic effect via direct action on the hypothalamic
heatregulating center, analgesic MOA unknown
c Adverse Reactions: hepatotoxicity, anemia, thrombocytopeni a, rash,
nausea
d Contraindication s: hepatic or renal impairment, chronic alcohol
abuse
2 NSAIDS- Nonsteroidal Anti- Inflammatory Drug
a Ibuprofen (Motrin) 400-800 mg PO q 4-6 hours, Max 2400mg/24
hours
b Naproxen (Naprosyn) 250- 500 mg PO q12 hours
c Meloxicam (Mobic) 7.5-15 mg PO daily
d Celecoxib (Celebrex) 200 mg PO daily
e Ketorolac (Toradol) 15-30 mg IV/IM/PO q 6 hours
f Indomethacin (Indocin) 25-50 mg PO TID
g MOA: Inhibits cyclooxygenase, reducing prostaglandin and
thromboxane synthesis
h Adverse Reactions: GI bleeding, MI, nephrotoxicity, hepatotoxicity,
dyspepsia, rash, fluid retention
i Contraindication s: GI bleed, CHF, fluid retention, renal or hepatic
impairment, asthma
b) Cold packs
c) Rest
d) Elevation
Laboratory
(1) CBC
(a) Anemia secondary to blood loss
1) Internal or external
Imaging
(1) Retrograde urethrogram
(a) Used to evaluate urethral injury
(b) URG will show extravasation of contrast in urethral injury
(2) Scrotal/Penile Ultrasound
(a) Including color flow Doppler
Treatment
(1) Immediate urological consultation is indicated for surgical repair
(a) Urethral injury
(b) Amputations
(c) Degloving
(d) Penetrating injuries
(e) Penile fracture
Complications
(1) Urethral injury
(a) Suspected if there is
1) Blood at the urethra meatus
2) Perineal hematoma
3) High riding prostate on DRE
(b) DO NOT attempt to place a Foley catheter if urethral injury is suspected
(2) Fournier’s gangrene
(3) Erectile dysfunction
(4) Urethral scaring/stricture
(5) Penile deformity (curvature)
Follow up
(1) MEDEVAC
(2) Referral to urology for injuries possibly requiring surgery
