Penile injuries are different in their origin and severity of damage to the skin, spongy and cavernous bodies, subcutaneous tissue, fascia, muscles and the protein membrane of the penis. Symptoms of penile injuries depend on the type of injury and may include swelling, pain, bleeding, hematoma, hematuria, urination disorders. Penile injuries are diagnosed on the basis of anamnesis, examination, palpation, ultrasound examination. First aid for penile injuries consists in stopping bleeding, wound PHO, removal of foreign bodies; further tactics are determined by the type and severity of the damage.
Penile injuries are injuries to the integumentary tissues and internal structures of the penis that occur when exposed to mechanical and thermal factors. Penile injuries account for 2.2% of all injuries and 30-50% of injuries to the genitourinary organs. In about 1% of cases, injuries are combined with injuries of the scrotum organs. Most often penile injuries occur in men aged 15-40 years. In urology and andrology, penile injuries are an urgent pathology and require urgent surgical care.
First of all, penile injuries are divided into closed (80%) and open (20%). Closed (blunt) injuries include bruises, pinches, dislocations and fractures of the penis. Open (penetrating) injuries include superficial, scalped, bitten, gunshot, stab wounds of the penis. In addition, in traumatology, patients with burns, frostbite, traumatic amputation of the penis (penectomy) are often found. Penile injuries can be either isolated or combined with damage to the organs of the scrotum, bones and pelvic organs.
Depending on the severity, the European Urological Association identifies the following types of penile injuries:
- Grade I – damage to the integumentary tissues, bruising of the penis
- Grade II – damage to the fascia of the Beech surrounding the spongy and cavernous bodies
- Grade III – tissue ruptures (glans penis, urethra, cavernous body) with a defect length of less than 2 cm
- Grade IV – rupture of the urethra, cavernous body with a defect length of more than 2 cm; partial amputation of the penis
- V degree – complete traumatic amputation of the penis.
Bruises are the most common type of penile injury. Most often, bruises occur with direct blows during sports and fights, cycling, etc. Light bruises of the penis are accompanied by painful sensations that subside within 10-15 minutes after the blow. For more severe injuries of the penis, accompanied by tearing of the protein membrane, it is characterized by increased pain, swelling of the penis, the formation of a subcutaneous hematoma that gives the penis a blue-purple color, difficulty walking, violation of urination. Strong targeted blows to the penis can lead to a fracture of the cavernous body and the development of internal bleeding. In this case, up to 0.5 liters of blood can accumulate under the skin of the penis in 15 minutes, which makes the penis become huge and blue-black in color. The blood accumulating in the subcutaneous tissue spreads to the pubis, scrotum and inner thigh. With severe penile injury and severe blood loss, traumatic shock may develop.
Infringement of the penis
This injury usually occurs when the skin of the penis gets into the zipper mechanism of the trousers. At the same time, a small wound forms on the surface of the penis, causing severe pain. Less often, the cause of infringement of the penis is pulling the trunk of the penis with a thread, an elastic band, putting various ring-shaped objects on it. These injuries can be caused as a result of childish pranks, mental abnormalities or in order to maintain an erection, prevent urinary incontinence.
Infringement of the penis is accompanied by the development of tissue edema and pain; when the urethra is compressed, acute urinary retention occurs. Prolonged violation of blood circulation in the tissues of the penis can lead to necrosis of the skin and gangrene of the penis.
Dislocation and fracture of the penis
Dislocation of the penis is a consequence of rupture of the ligaments with which the penis is fixed to the bones of the pelvis. With this type of injury to the penis, the cavernous bodies are displaced under the skin of the thigh, perineum, scrotum, and the penis itself is palpated in the form of an empty skin sac.
A fracture of the penis in most cases occurs during rough sexual intercourse and is a consequence of a sharp inflection of the erect penis. Such an injury to the penis is accompanied by a rupture of the cavernous bodies and can be combined with damage to the urethra and the spongy body. Usually, at the moment of a fracture, a characteristic crack is clearly heard, which patients compare with the crunch of broken glass. At the same time, an attack of acute pain occurs and the erection stops. The consequence of the internal bleeding that has begun is the appearance and rapid increase of hematoma, increased intensity of pain, shock phenomena. If the urethra is damaged, there is a delay in urination. Penile fracture is a dangerous type of injury, the long–term consequences of which can be infectious complications, penile curvature, painful erections, impotence.
Open penile injuries
Superficial wounds of the penis include injuries resulting from excessive friction, tears and tears of the short frenulum of the foreskin. Such injuries may be accompanied by external bleeding of varying intensity, scarring. The reason for the formation of scalped wounds of the penis is the penetration of the penis into various kinds of moving mechanisms. At the same time, extensive wound defects of the skin are formed, often passing to the scrotum, intense pain, bleeding, traumatic shock occur.
Bitten wounds of the penis are a consequence of the aggression of pets or deliberate actions of the sexual partner. Despite a small area of damage and minor bleeding, penis bites, as a rule, are always infected, so such wounds tend to take a long time to regenerate. Bites inflicted by animals carry the risk of rabies infection.
Stab wounds of the penis occur as a result of damage caused by piercing and cutting objects (knife, nail, awl, etc.), less often due to iatrogenic causes (improper circumcision operation). Penile injuries with such a mechanism of application are accompanied by damage to the cavernous bodies, the hanging part of the urethra, sometimes by complete or partial penectomy. With gunshot wounds of the penis, in addition to the urethra and cavernous bodies, the scrotum, soft tissues, bones, pelvic organs are often damaged. The leading symptoms of such penile injuries are bleeding, often urine discharge from the wound passage; the presence of foreign bodies in the wound.
The cause of traumatic amputation of the penis may be violent criminal acts (wounds, bites) or self-mutilation associated with an exacerbation of mental illness. Partial and complete penectomy is accompanied by massive bleeding, shock, violation of urination.
Thermal injuries of the penis
Factors contributing to frostbite of the genital organ are general hypothermia, urination in the cold, alcohol intoxication. Frostbite is more often exposed to the foreskin, less often – the body of the penis. As a result of cold trauma, the skin on the affected area acquires a purplish-blue hue; burning, itching, tingling, paresthesia, swelling of the penis occur. With a mild degree of frostbite, these phenomena spontaneously disappear within a few days. In more severe cases, tissue necrosis forms on the affected areas of the skin, deep purulent ulcers, the healing of which is delayed for 3 or more months.
Burns of the penis occur as a result of exposure to the genital area of hot liquids, chemicals, sunlight, etc. A burn of the I degree is accompanied by hyperemia and swelling of the penis; II degree – the formation of blisters, subcutaneous edema, urinary retention; III degree – necrosis of the skin; IV degree – necrosis of the spongy and cavernous bodies.
Any injuries to the penis require immediate treatment in a medical institution, where the victim must be examined by a surgeon, traumatologist or urologist. Preliminary diagnosis of the type of injury is based on the data of anamnesis, examination and palpation of the penis. In the future, to clarify the severity of the injury, ultrasound of the penis, Doppler ultrasound, cavernosography, MRI may be recommended. Since penile injuries often occur with damage to the urethra, urethroscopy or urethrography may be required to exclude damage to the urethra.
At the pre-hospital stage, victims with penile injuries need competent emergency care. As a matter of priority, it is necessary to take measures to temporarily stop the bleeding (apply ice, a pressing aseptic bandage on the penis, a tourniquet), splint the penis when it is fractured, and begin anti-shock measures (adequate anesthesia, infusion therapy). In the hospital, the PHO of the Russian Academy of Sciences is performed (including burn surface, gunshot wound, infected wound), removal of foreign bodies, drainage of post-traumatic hematomas, revision of the wound and final stop of bleeding. Patients with bitten wounds are necessarily vaccinated against rabies; with other wounds, tetanus is injected, according to indications, anti–gangrenous serum.
Treatment of penile infringement will consist in the removal of squeezing objects. In case of dislocation of the penis, its open reduction is carried out with suturing of the torn ligaments and fixation of the cavernous bodies to the pelvic bones. When the penis is fractured, an operative opening of the hematoma is performed with the removal of blood clots; hemostasis, suturing of defects of the protein membrane and cavernous bodies, drainage of the wound. Ruptures of the frenulum of the penis require frenuloplasty. The elimination of extensive wound defects is carried out using methods of skin grafting, for which the skin of the scrotum (Reich’s operation), pubic area, abdomen, free skin flaps are used. Treatment of thermal injuries of the penis is carried out according to the general principles of treatment of burns and frostbite.
If the urethra is damaged, an epicystostomy is applied. Restoration of the continuity of the urethra is carried out by performing anastomotic urethroplasty or other types of urethral plasty. The penis amputated by negligence must be preserved, because during the first 24 hours after the injury, its microsurgical insertion into the stump is possible. To maintain the viability of the organ, it is washed and stored in a sterile container filled with sodium lactate solution on ice. If reimplantation is not possible, reconstructive phalloplasty is performed.
Prognosis and prevention
Penile injuries are serious injuries that require urgent medical attention, comprehensive diagnostics and qualified assistance. The long-term consequences of unrecognized penile injuries may be cavernitis, abscesses, deformities and shortening of the penis, erectile dysfunction, urethral strictures. To prevent damage to the penis will allow the protection of the genitals when practicing traumatic sports, avoiding dangerous positions in sex, increasing the level of sexual culture and sex education, careful handling of pets.