Penile Injury: Four Years’ Experience of a Single Surgeon in a Limited Resources Setting

Abstract

Background: Penile injuries (PIs) are uncommon, with the management of severe cases being difficult. This study aims to examine the causes of PIs and present experience for their management using the limited facilities available in a hospital with low-resource settings.


Methods: The management of PIs in a limited-resource hospital in eastern Sudan was recorded over four years. Records of 32 cases of emergency penile surgical conditions between January 2016 and March 2020 were retrospectively reviewed, and 17 cases of significant PI were included in the study and divided into pediatric and adult groups with further subdivision of each group according to the nature of the injury.


Results: Seventeen patients with PIs were treated during the study period. The pediatric group (n = 4) were victims of traditional circumcision; two of them presented with glans penis (GP) amputation, one with gangrenous GP, and one with mild GP injury. The patients in the adult group were divided into three subgroups; the first group had penile fractures (n = 8), the second group had degloving PIs (n = 2), and the third group had penile amputation injuries (n = 3). Management included various surgical techniques tailored to the individual patients. The outcome of the intervention was presented on a case-by-case basis.


Conclusion: Severe PIs should be managed using a case-by-case approach. To enhance the effectiveness of surgical interventions, the field of reconstructive penile surgery must be established and developed. Community orientation and work safety measures should be implemented to avoid PIs that may result from traditional circumcision and machinery trauma.

Keywords:

penile injuries, glans penis, fracture, amputation, circumcision, degloving

References
[1] Djordjevic, M. L., Bizic, M., Stojanovic, B., Joksic, I., Bumbasirevic, U. V., Ducic, S., Mugabe, H., Krstic, Z., & Bumbasirevic, M. Z. (2019). Outcomes and special techniques for treatment of penile amputation injury. Injury, 50(Suppl 5), S131–S136. https://doi.org/10.1016/j.injury.2019.10.064

[2] Mensah, J. E., Bray, L. D., Akpakli, E., Kyei, M. Y., & Oyortey, M. (2017). Successful penile reimplantation and systematic review of world literature. African Journal of Urology, 23, 253–257. https://doi.org/10.1016/j.afju.2017.02.003

[3] Oranusi, C. K., & Nwofor, A. (2014). Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria. Nigerian Journal of Clinical Practice, 17, 763–766. https://doi.org/10.4103/1119-3077.144392

[4] Garaffa, G., Gentile, V., Antonini, G., Tsafrakidis, P., Raheem, A. A., & Ralph, D. J. (2013). Penile reconstruction in the male. Arab Journal of Urology, 11, 267–271. https://doi.org/10.1016/j.aju.2013.04.003

[5] Djordjevic, M. L., Bumbasirevic, M. Z., Krstic, Z., Bizic, M. R., Stojanovic, B. Z., Miocinovic, R., & Santucci, R. A. (2014). Severe penile injuries in children and adolescents: Reconstruction modalities and outcomes. Urology, 83, 465–470. https://doi.org/10.1016/j.urology.2013.10.015

[6] Yao, A., Ingargiola, M. J., Lopez, C. D., Sanati-Mehrizy, P., Burish, N. M., Jablonka, E. M., Taub, P. J. (2018). Total penile reconstruction: A systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(6), 788–806.

[7] Maruschke, M., Lehr, C., & Hakenberg, O. W. (2008). Traumatic penile injuries—Mechanisms and treatment. Urologia Internationalis, 81, 367–369. https://doi.org/10.1159/000151421

[8] Persec, Z., Persec, J., Puskar, D., Sovic, T., Hrgovic, Z., & Fassbender, W. J. (2011). Penile injury and effect on male sexual function. Andrologia, 43, 213–216. https://doi.org/10.1111/j.1439-0272.2010.01072.x

[9] Krishna Reddy, S. V., Shaik, A. B., & Sreenivas, K. (2014). Penile injuries: A 10-year experience. Canadian Urological Association Journal, 8, E626–E631. https://doi.org/10.5489/cuaj.1821

[10] Riyach, O., El Majdoub, A., Tazi, M. F., El Ammari, J. E., El Fassi, M. J., Khallouk, A., & Farih, M. H. (2014). Successful replantation of an amputated penis: A case report and review of the literature. Journal of Medical Case Reports, 8, 125. https://doi.org/10.1186/1752-1947-8-125

[11] Yang, K., Liu, Y., Wang, W., Xiao, Y., Li, X., & Zhou, L. (2019). Successful penile replantation after macroscopic repair using vein blood-letting therapy. Urology Case Reports, 28, 101069. https://doi.org/10.1016/j.eucr.2019.101069

[12] Hammoodi Al-Ani, S. K. (2020). Male circumcision using bone cutter with thermal cautery. Mustansiriya Medical Journal, 19, 49. https://doi.org/10.4103/MJ.MJ_29_20

[13] Petrella, F., Amar, S., El-Sherbiny, M., & Capolicchio, J. P. (2021). Total glans amputation after neonatal circumcision. Urology Case Reports, 37, 101624. https://doi.org/10.1016/j.eucr.2021.101624

[14] Onumaegbu, O. O., & Okechukwu, O. C. (2015). Isolated penile degloving from milling machine injury in a child. Annals of Medical and Health Sciences Research, 5, 139–141. https://doi.org/10.4103/2141-9248.153629

[15] Rodriguez, D., Li, K., Apoj, M., & Munarriz, R. (2019). Epidemiology of penile fractures in United States emergency departments: Access to care disparities may lead to suboptimal outcomes. Journal of Sexual Medicine, 16, 248–256. https://doi.org/10.1016/j.jsxm.2018.12.009

[16] Panella, P., Pepe, P., & Pennisi, M. (2020). Diagnosis and treatment of penile injury: Ten years experience of an emergency department. Archivio Italiano di Urologia e Andrologia, 92, 192–195.

[17] Mehra, K., Kalra, S., Narayanan, D. L., Ramanitharan, M., & Sreenivasan, S. (2019). Emergency urethroplasty for penile urethral injury in a case of blunt trauma of the penis: Challenges and dilemmas during management. Malawi Medical Journal, 31, 259–260. https://doi.org/10.4314/mmj.v31i4.8

[18] Shukla, A. K., Bhagavan, B. C., Sanjay, S. C., Krishnappa, N., Sahadev, R., & v, S. (2015). Role of ultraosonography in grading of penile fractures. Journal of Clinical and Diagnostic Research: JCDR, 9, TC01–TC03. https://doi.org/10.7860/JCDR/2015/11628.5754

[19] Mathur, R. K., Lahoti, B. K., Aggarwal, G., & Satsangi, B. (2010). Degloving injury to the penis. African Journal of Paediatric Surgery: AJPS, 7, 19–21. https://doi.org/10.4103/0189-6725.59354

[20] Caygill, P. L., Floyd, M. S., Jr., New, F. J., & Davies, M. C. (2018). A successful microsurgical approach to treating penile amputation following genital self-mutilation. Journal of Surgical Case Reports, 2018, rjy271. https://doi.org/10.1093/jscr/rjy271

[21] Rashid, M., & Sarwar, S. U. R. (2005). Avulsion injuries of the male external genitalia: Classification and reconstruction with the customised radial forearm free flap. British Journal of Plastic Surgery, 58, 585–592. https://doi.org/10.1016/j.bjps.2004.12.014

[22] Hawksworth, D. J., Cooney, D. S., Burnett, A. L., Bivalacqua, T. J., & Redett, R. J. (2019). Penile allotransplantation: Pushing the limits. European Urology Focus, 5, 533–535. https://doi.org/10.1016/j.euf.2019.08.004