male genital trauma
DESCRIPTION
Male genital traumaTRANSCRIPT
![Page 1: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/1.jpg)
MALE GENITAL TRAUMA
Amy McAllister
April 2014
![Page 2: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/2.jpg)
Contents
Anatomical approach Causes Symptoms & Signs Investigations Management Learning points
![Page 3: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/3.jpg)
Introduction
GUT injury in ~10% of all trauma patients
Long term morbidity
-incontinence
-impotence
-psychological Usually not life threatening; need to rule
out other injuries
![Page 4: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/4.jpg)
Aetiology Penetrating
- Knife, bullet Blunt
- MVA
- fall from height
- direct blow/ sports
- straddle injury
- Constriction, Instrumentation Also – avulsion, burns, radiation, iatrogenic
![Page 5: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/5.jpg)
Penile injuries
Penile “fracture” Rupture of the tunica albuginea of one
or both of the corpora cavernosa.
![Page 6: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/6.jpg)
Penile fracture Aetiolgy
- Frequently a sexually related accident but can also be from a direct blow
- May be associated with urethral injury
Investigations
- Usually history is enough
- Diagnostic cavernosography or MRI
Management
- Previous conservative treatment – high complication rates
- Surgery
![Page 7: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/7.jpg)
Penile fracture
“Eggplant” deformityFascial layers of the penis
![Page 8: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/8.jpg)
Penile amputation
Accidental or deliberate “Double Bag” preservation
Management Reimplantation - success has been
reported after 16 hours of cold ischaemia
![Page 9: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/9.jpg)
Penile soft tissue injuries
Penetrating injuries Dog bites Constriction Degloving
Management Sutures Removal of constricting devices Surgery
![Page 10: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/10.jpg)
Testicular injuries•Haematocele
•Haematoma
•Testicular rupture
•Testicular dislocation/ torsion
![Page 11: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/11.jpg)
Testicular injuries
Signs Bruising, swelling, tenderness,
haematuria
Investigation USS Surgical exploration
![Page 12: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/12.jpg)
Testicular rupture
Normal testis Testicular rupture(6)
![Page 13: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/13.jpg)
Urethral injuriesProstatic
Membranous
Bulbous
Pendulous
Anterior urethra
Posterior urethra (most common)
![Page 14: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/14.jpg)
Posterior urethral injury
Commonly associated with pelvic # Violent mechanism
![Page 15: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/15.jpg)
Posterior urethral injury
Signs
Blood at meatusGross haematuriaInability to voidEcchymoses, swelling of penisPelvic/suprapubic tenderness“High riding”/absent prostate on DRE
![Page 16: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/16.jpg)
Anterior urethral injury
Direct trauma history Straddle injury Usually no pelvic # Similar signs to
posterior
Investigations Urinalysis Retrograde
urethrogram
![Page 17: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/17.jpg)
Urinalysis
*False positives* Rhabdomyolysis Food – berries/beets Drugs – Rifampicin, Alphamethyldopa
etc
If more than a trace on dipstick – send for urinalysis
![Page 18: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/18.jpg)
Retrograde urethrogram Patient tilted at 45 degrees Initial KUB film taken Penis sretched obliquely
over thigh to promote visualization of the entire urethra
Inject 25mls of water-soluble contrast using specialised adaptor or Foley catheter
Re-xray
![Page 19: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/19.jpg)
Goldman classification of urethral trauma
![Page 20: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/20.jpg)
Retrograde urethrogram
Normal Goldman type III urethral injury
![Page 21: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/21.jpg)
Urethral injuries Management
Posterior Partial tear - Foley catheter Complete tear – Suprapubic catheter, surgery
Anterior - surgery
NB. If Foley already in place and suspect tear, do not remove
![Page 22: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/22.jpg)
Bladder injuries
Degree of injury
•Contusion (most common) •Extraperitoneal rupture•Intraperitoneal rupture•Combined intraperitoneal/extraperitoneal rupture
![Page 23: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/23.jpg)
Bladder injuries Aetiology
- pelvic # in up to 70% of cases
- blunt abdominal trauma with full bladder
![Page 24: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/24.jpg)
Bladder rupture
![Page 25: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/25.jpg)
Bladder injuriesSigns Gross haematuria Microscopic haematuria with pelvic # Bruising, suprapubic tenderness, peritonism Must rule out urethral injury before placing Foley
Investigations Retrograde CT cystography
Management Contusions/extraperitoneal – conservative Intraperitoneal - surgery
![Page 26: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/26.jpg)
Ureteral injuries
Ureter injury is rare except a complication of surgery/ penetrating trauma
No haematuria in 25% of ureter injuries Have high index of suspicion
![Page 27: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/27.jpg)
Renal injuries
Usually blunt trauma Sudden deceleration MVA / bicycle accidents
Lumbar transverse process #
![Page 28: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/28.jpg)
Renal injuriesSigns
• Eccyhmosis to back / flank / lower thorax / upper abdomen
• Haematuria• Shock
Delayed findings
•Fever•Palpable flank mass (urinoma)
![Page 29: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/29.jpg)
Renal injuries
Investigations
CT with contrast IVP
![Page 30: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/30.jpg)
Classification of renal injuries
![Page 31: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/31.jpg)
Renal injuries
Management
ABCs Grade I and II – conservative Grade III and up – operative including
nephrectomy
![Page 32: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/32.jpg)
Learning points
Rule out life threatening injuries first Identification prevents long term
problems No Foley if urethral trauma suspected –
wait for u/a and pelvic x-ray If Foley is in – do not remove if urethral
trauma suspected afterwards Gross haematuria or microscopic
haematuria plus shock = GUT trauma
![Page 33: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/33.jpg)
References (1) Urol Clin North Am. 2013 Aug;40(3):323-34. doi:
10.1016/j.ucl.2013.04.001. Epub 2013 Jun 12.Current epidemiology of genitourinary trauma. McGeady JB1, Breyer BN
(2) Bhatt S, Kocakoc E, Rubens DJ, Seftel AD, Dogra VS (2005)Sonographic evaluation of penile trauma. J Ultrasound Med 24:993–1000, quiz 1001
(3) Kozacioglu Z., Degirmenci T., Arslan M., et al : Long-term significance of the number of hours until surgical repair of
penile fractures. Urol Int 2011; 87: 75-79 CrossRef (4) J Urol. 2004 Aug;172(2):576-9. Long-term experience with surgical and conservative treatment of
penile fracture. Muentener M1, Suter S, Hauri D, Sulser T. (5) Wei F.C., McKee N.H., Huerta F.J., et al : Microsurgical replantation of a completely amputated penis. Ann Plast
Surg 1983; 20: 317-321 CrossRef
![Page 34: Male genital trauma](https://reader031.vdocuments.mx/reader031/viewer/2022012922/54816c46b4af9fce158b5f28/html5/thumbnails/34.jpg)
References (6) Bhandary P, Abbitt PL, Watson L (1992) Ultrasound
diagnosis of traumatic testicular rupture. J Clin Ultrasound 20:346–348
(7) Lower male genitourinary trauma: a pictorial review Bruce E. Lehnert & Claudia Sadro & Eric Monroe &Mariam Moshiri
(8)Gomez RG, Ceballos L, CoburnMet al (2004) Consensus statement
on bladder injuries. BJU Int 94:27–32(2)Ramchandani P, Buckler PM (2009) Imaging of genitourinary trauma. AJR Am J Roentgenol 192:1514–1523
(9) Straddle injuries to the bulbar urethra: management and outcome in 53 patients Elgammal MA.Int Braz J Urol. 2009 Jul-Aug;35(4):450-8. .