Urethral and penile war injuries: The experience from civil violence in Iraq

Using Urethroplasty as an immediate treatment for gunshot-induced penis injury during the Syrian war: Case report

INTRODUCTION AND IMPORTANCE

Wars and armed conflicts often result in gunshot injuries, including penile trauma, in military personnel or civilians. Urinary system damage occurs in 0.5-4.2 % of cases involving harm to all organs and systems during combat conflicts. We report the immediate Urethroplasty for gunshot-induced penile injury.

CASE PRESENTATION

A 25-year-old Syrian soldier presented to the emergency department with difficulty urinating due to a gunshot wound to the penis. Physical examination showed bruising on the scrotum and penis. Computed tomography scan confirmed a gunshot injury to the bulbar urethra. Under general anesthesia, a circumcised incision was made and it was observed a significant loss of 14 cm of the penile and bulbar urethra on the ventral side. The bullet was removed. The urethral plate was suspended, sutures were placed on the dorsal side, and a graft was taken from the dermis of the left Iliac skin for ventral urethroplasty. A follow-up retrograde urethrogram showed normal results.

CLINICAL DISCUSSION

Injuries of genitourinary from trauma, particularly involving the penis, are uncommon. Generally, gunshot wounds to the penis can cause various injuries, ranging from superficial to deep. The trauma team and urologists should stay alert in evaluating the patient for additional injuries outside the genitourinary system, particularly rectum, colon, and/or small bowel injuries, which were present in over 50 % of the major non-genitourinary injuries observed.

CONCLUSION

Although urinary and reproductive system injuries are uncommon, their management is important for every urologist and emergency physician because they have physical and psychological effects on the patient.

Penile Trauma Burden and Aetiology in the Paediatric and Adult Population: A Scoping Review and Critical Analysis of the Literature

Penile trauma is rare. It is associated with the impairment of physiological functions and deterioration in patients' quality of life. Currently, the relevance of age demographics in the occurrence of this debilitating injury has not been well discussed. The objective of this study was to provide a scoping review of penile trauma within the lens of the legal age of maturity. A search of the PubMed, Scopus and Web of Science databases was conducted, and then, the identified publications were used to conduct this scoping review focussing on the study aim. The results identified were categorised into five themes. This included publication information (author, year, country, study duration); demographic information (age of presentation, number of patients, relative burden); penile trauma clinical pattern (type, severity, associated injury), risk factors and clinical consequences. While mobile and active young adults were at risk of outdoor trauma, the report on penile trauma in the paediatric population is rare and usually focussed on sexual trauma. Penetrating trauma has been more extensively studied in comparison to blunt penile trauma despite the significance of the latter in the paediatric population. Injury severity classification is not available for most studies limiting their usefulness in the universal comparison of trauma severity and injury prognostication. There is a diversity in the burden and presentation of penile trauma. Available research studies are limited in the paediatric population, mostly focussed on penile fracture in adults and generally devoid of a standardised penile trauma severity description. Additional studies with a specific focus on penile trauma are required to characterise aetiological risks and injury severity across the legal age of maturity.

Penetrating gunshot wounds to the penis: a case report of combat patient injured in the war in Ukraine

BACKGROUND

The current war in Ukraine is associated with frequent applications of multiple-launch rocket systems and cruise missiles as well as other various high-energy weapons to cause severe injuries in military personnel including abdomen wounds, vascular injury, and limb amputations as well as genitourinary trauma. The aim of this report is to demonstrate a case of successful penile salvage by restoring its function in a combat patient with gunshot genitourinary trauma in conditions of an interrupted supply of medical equipment.

CASE PRESENTATION

We describe a case of a 48-year-old male patient with a combined shrapnel gunshot wound to the penis with damage to the urethra and combined injury to the soft tissues of the left thigh. Several hours after the injury, the patient underwent primary surgical debridement of the left thigh, ligation of the great saphenous vein of the thigh, primary sutures on the penile urethra and navicular fossa, suturing of the rupture of the head and penis, drainage of the wound, catheterization of the bladder, and epicystostomy. An artificial erection was performed intraoperatively. The urethral catheter was removed 3 weeks after urethral suturing (May 4, 2022). The epicystostomy was removed 5 months after the injury (August 4, 2022) and 2 days after the restoration of spontaneous urination. At the follow-up of 7 months after the injury, the patient has normal urination with minor urinary dribbling, sufficient erection, and ejaculation.

CONCLUSIONS

We have shown that in a case of gunshot wounds to the penis and hanging part of the urethra, even in the presence of combined severe purulent lesions of non-urological localizations, it is possible to perform a primary reconstruction of urogenital injuries using a primary urethral suture and applying a negative pressure device. Findings from this case report shed new light on the management of penile gunshot injury in ongoing warfare as well as provide evidence of the possibility to perform adequate management for penile injury in conditions of limited medical resources, violation of international humanitarian law, and under frequent strikes of high-energy weapons.

Self-inflicted gunshot injury to the external genitalia: a case report and review of literature

Background

Gunshot wounds of the external genitalia are rare. Rarer still are civilian self-inflicted gunshot wounds of the external genitalia. The protocol for the management of gunshot wounds of the penis especially with respect to urethral injuries is not fully established.

Case presentation

We present a 27-year-old male undergraduate student, who accidentally shot himself in the penis. He sustained American Association for the Surgery of Trauma (AAST) grades IV to V injuries to the penis, scrotum and left testes. He was managed in a multistage, multi-disciplinary fashion including staged buccal mucosal graft repair of 4 cm proximal penile urethral defect with satisfactory cosmetic and functional outcome.

Conclusions

Excellent functional and cosmetic results may be obtained after severe penetrating trauma to the external genitalia even in low resource centres in the hands of non-reconstructive urologists. Buccal mucosal graft is a viable option for two stage reconstruction of the urethra.

War-related penile injuries in Libya: Single-institution experience

Objective

To report on our initial experience in the management of war-related penile injuries; proper diagnosis and immediate treatment of penile injuries is essential to gain satisfactory results. Besides treating primary wounds and restoring penile function, the cosmetic result is also an important issue for the surgeon.

Patients and methods

The study was conducted in the Department of Urology at Benghazi Medical Center and comprised all patients who presented with a shotgun, gunshot or explosive penile injury between February 2011 and August 2017. The patient’s age, cause of injury, site and severity of injuries, management, postoperative complications, and hospital stay, were recorded.

Results

In all, 29 males with war-related penile injuries were enrolled in the study. The mean (SD) age of these patients was 31.3 (10.5) years. The glans, urethra, and corporal bodies were involved in four (13.7%), 10 (34.4%), and 20 (68.9%) of the patients, respectively. According to the American Association for the Surgery of Trauma Penis Injury Scale, Grade III penile injuries were the most common (11 patients, 37.9%). The most common post-intervention complications were urethral stricture with or without proximal urethrocutaneous fistula (eight patients, 27.5%), followed by permanent erectile dysfunction (five patients, 17.2%).

Conclusion

In patients who sustain war-related penile injuries the surgeon’s efforts should not only be directed to restoring normal voiding and erectile function but also on the cosmetic appearance of the penis.