INJURIES OF THE PENIS AND SCROTUM

BRUISING is the result of injury to the patient’s non–erect organ. Treat it as a urethral injury. Can he pass urine? if he can, his urethra is not seriously injured.

If he cannot pass urine, insert a suprapubic catheter, and treat him as a urethral injury.

If his penis starts to swell with blood or urine, treat him as for a fractured penis as described below.

OPEN WOUNDS Do a wound toilet, you will probably not need to excise any skin. The urethra may be very difficult to recognize in the bleeding tissue—don’t injure it! if in doubt, assume that injured tissue will recover. Use delayed closure.

If the penis needs bandaging, let this mimic the erect position. if the urethra is injured, insert a suprapubic catheter.

AVULSION (DEGLOVING) INJURIES if any flaps of skin remain on a patient’s injured penis, even if they are completely detached, replace them immediately, because they will probably live.

Figure 68.7: AN INJURY OF THE TESTIS. A, the patient’s injury. B, a generous toilet. C, his tunics being closed. D, his scrotum being E, a drain in his scrotum. From the Early Care of the Injured Patient. The committee on Trauma of the American College of Surgeons. Edited by A.J. Walt. With kind permission.

If any part of the shaft of his penis is bare, cover it with split skin, allowing for contraction. Cover the graft with a firm, even dressing. Or, if the deep layer of his foreskin remains attached to the shaft proximal to the corona, you may be able to use both layers to make a high quality flap or graft.

Alternatively, bury the shaft of a patient’s penis in his scrotum and release it later.

If any flaps of scrotal skin remain, remove them.

If the skin of his scrotum has been avulsed, but enough remains, try to make a bag for his testes. If necessary, undercut the skin of his thighs. Or, make incisions in his thighs to hold his testes and cords until you can refer him for a plastic repair.

FRACTURE OF THE PENIS is the result of the sudden posterior angulation of an erect penis. Open up the huge swelling with an incision over the most swollen part and evacuate the clot. Then suture the capsule of the ruptured corpora cavernosa.

If the patient’s corpus spongiosum and urethra have been fractured, insert a suprapubic catheter for 3 weeks and proceed as for a urethral injury (68.5).

DIFFICULTIES WITH INJURIES OF THE PENIS AND SCROTUM

If a patient’s TESTIS IS INJURED, toilet his wound, then clean and close his tunics albuginea. Drain his scrotum only and don’t insert a drain under his tunics.

If his PENIS IS JAMMED in a circular object, the distal part becomes engorged and swollen. In early cases try sucking some of the blood from his corpora cavernosa with a needle and syringe, then compress the distal part with cold compresses for 15 minutes. In later cases you will have to open up the circular object, if necessary under general anaesthesia.

If the distal part of his penis becomes gangrenous, amputate it, and proceed as for carcinoma of the penis (Chapter 32).