A penile injury is a

medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...

that afflicts the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...

. Common injuries include

fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displ ...

avulsion injury In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery (from the Latin ''avellere'', meaning "to tear off"). The term most commonly refers to a surface trauma where all layers of the skin have been ...

, strangulation, entrapment, and amputation.

Epidemiology

Penetrating and blunt traumas combined make up approximately 90% of all civilian penile injuries (45% each), with burns and other accidents making up the remaining 10%.

Types

Fracture

Penile fractures are the result of rupture of the tunica albuginea. They are fairly rare and can co-occur with partial or complete

urethral rupture Rupture of the urethra is an uncommon result of penile injury, incorrect catheter insertion, straddle injury, or pelvic girdle fracture. The urethra, the muscular tube that allows for urination, may be damaged by trauma. When urethral rupture occu ...

, though this is rare. Urethral damage occurs in 10–38% of cases. Fractures are treated with emergency surgery, and can be diagnosed with

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

, especially in pediatric cases. Penile fractures are caused by trauma to the erect penis, typically by suddenly bending it laterally during penetrative intercourse with the receptive partner on top of the penetrating partner, or during masturbation. Characterized by a loud popping sound at the time of the injury, the result of the tunica albuginea rupturing. Other symptoms include severe pain, loss of erection, and swelling. Symptoms of urethral injury include hematuria, blood at the meatus, and dysuria. If left untreated, complications result in 28–53% of cases; these include permanent curvature of the penis,

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

, urethral diverticulum,

priapism Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases ...

, and erectile dysfunction.

Degloving and avulsion

Degloving and avulsion injuries involve the removal of the penis skin, which is a serious medical emergency. Treatment of these injuries involves either closure of the torn skin, or a skin graft to replace the skin lost in the injury. Skin grafts are constructed to attempt to preserve erectile function and sensation.

Soft-tissue injuries

Strangulation

Strangulation injuries to the penis, also called incarceration injuries, caused by hair, rubber bands, or other objects are the second most common soft tissue injury in children. Hair strangulation may be hard to diagnose due to the anatomy of the penis; the hair causing the strangulation may be hidden under the coronal sulcus if it is swollen. In adults, strangulation injuries that require medical treatment can be caused by a variety of objects typically used for the purpose of sexual gratification, extending the time of an erection, or

enuresis Enuresis is a repeated inability to control urination. Use of the term is usually limited to describing people old enough to be expected to exercise such control. Involuntary urination is also known as urinary incontinence. The term "enuresis" co ...

, including metal rings, which must be removed by specialized cutting instruments. The object can also be removed by decompressing the penis. Because the vasculature of the penis is compressed, a variety of complications can result from strangulation injuries, depending on whether the veins, arteries, or both are compressed, including mild, reversible vascular obstruction; ischemic necrosis; gangrene and

kidney damage Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can b ...

;

lymphedema Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fl ...

; ulceration; urethrocutaneous fistula, loss of sensation; urethral injury;

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

; and autoamputation. Penile strangulation injuries that require medical attention are rare: since their first description in 1755, there have been approximately 60–120 reported cases. Though usually acute, cases of chronic strangulation and acute cases lasting up to one month have been reported. Various objects have been involved in cases of strangulation: *

Wedding ring A wedding ring or wedding band is a finger ring that indicates that its wearer is married. It is usually forged from metal, traditionally gold or another precious metal. Rings were used in ancient Rome during marriage, though the modern prac ...

* Steel ring * Bottle * Chastity belt

Entrapment

The most common soft-tissue injury is an entrapment injury involving the penis caught in a zipper; these injuries are particularly common in young children who are uncircumcised and are always superficial. They are treated by removing the zipper with

local anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...

using a bone cutter, lubrication, or hacksaw, dismantling the zipper, or removing the affected tissue, and can be prevented in most situations by

circumcision Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Top ...

. If not treated promptly, the affected tissue can swell and become infected. In some cases, emergency circumcision is necessary.

Other

Other soft-tissue injuries to the penis can be caused by burns,

animal bite An animal bite is a wound, usually a puncture or laceration, caused by the teeth. An animal bite usually results in a break in the skin but also includes contusions from the excessive pressure on body tissue from the bite. The contusions can occu ...

s, and human bites. Animal bites are common in children, and dogs are the most common animals involved. Though typically not severe, animal bites can cause amputation or infection. Treatment for animal bites and human bites involves antibiotic treatment and closure of the wounds by secondary intention because they are contaminated. Penis burns can be very severe and often require specialized care in a

burn unit A burn center, burn unit, or burns unit is a hospital specializing in the treatment of burns. Burn centers are often used for the treatment and recovery of patients with more severe burns. Overview The severity of a burn, and therefore whether ...

to prevent contractures, severe scarring, or other complications including lymphedema, hypospadias, or necrosis. This treatment can involve debridement, skin grafts, antibiotics, and the use of a suprapubic catheter. Because of its thin skin, the penis is susceptible to full-thickness, third-degree burns. Burns to the penis typically co-occur with other severe burns. Most thermal penis burns are first or second degree burns caused by flame; some are caused by grease or boiling water. Electrical burns are typically deeper than thermal burns and require more extensive tissue removal.

Amputation

Amputation of the penis can be either partial or complete. Often self-inflicted by people with

psychiatric disorders A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

, it may be occur with other trauma, such as in an assault or a mechanical accident. These injuries are treated by re-implantation if possible, with or without anastomosis of the vasculature to restore erectile function; skin necrosis and loss of sensation are common complications after treatment.

Microsurgery Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) whic ...

on the vasculature decreases the risk of necrosis significantly. Klingsor syndrome is a psychiatric disorder that causes self-harm, which can involve the penis.

Paranoid schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...

, eating disorders, and

psychotic break Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior t ...

s can also be associated with penile injury. In some cases,

transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through ...

people who are not able to access genital surgery may self-amputate their penis. Favorable prognostic factors for replantation of amputated penises include short ischemic time and a clean incision (as opposed to a crush injury or ragged incision). Replantation of an amputated penis can be done up to 24 hours after the injury, though fewer than 16 hours of cold ischemia or 6 hours of warm ischemia leads to the best outcomes. If replantation is not possible or desired, a penile stump can be closed and

phalloplasty Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement. History Russian surgeon Nikolaj Bogoraz performed the fir ...

could be performed later.

Penetration

Penetrating injuries can be caused by accidents during sexual activities (typically, by foreign objects inserted into the urethra), by weapons (i.e. bullets) during wartime, or by stabbing. These injuries can have varying severity and be superficial, affect the corpora cavernosa, other soft tissue, and/or urethra. In 50% of cases, the urethra is injured. Some foreign objects may be removed like any other penetrating object in soft tissue; using forceps and gentle traction. However, if the foreign object was inserted into the urethra or has damaged the urethra transversely, urethography is used to avoid further injury to the urinary tract while removing the object. Penetrating injuries make up approximately 45% of civilian penile injuries.

Classification

Causes

The causes of penile injury are mostly the same as other causes of trauma; however, penile injury is more likely to occur during sexual intercourse and masturbation than other traumas. Nocturnal erections and sleeping positions can be another cause of penile injury. Industrial and automobile accidents can also cause penile injury. Self-injury may also affect the penis. $Penile fracture$

Diagnosis

Most penile trauma can be diagnosed by history and physical examination, hearing 'snapping' or 'popping' sound, immediate penile pain, swollen, bruised (often known as eggplant deformity), some may notice blood over the urethral meatus. But in some cases, ultrasonography can indicate the extent of the injury and help a clinician decide if the injured person needs surgical treatment. It is important to rule out urethral injury in those with penile injury, as it is a urological emergency that may result in significant morbidity if left untreated.

Treatment

The type of injury dictates the treatment; however, surgery is a common treatment. Most traumatic penile injury warrant an emergency repairing surgery to prevent complications and maintain functionality of the penis sexually and urologically. Catheterization is usually a part of treatment for penis injuries; when the urethra is intact, urethral catheterization may be used, but if it has been injured, suprapubic catheterization is used. Some injuries, including animal bites, are also treated with

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

irrigation Irrigation (also referred to as watering) is the practice of applying controlled amounts of water to land to help grow crops, landscape plants, and lawns. Irrigation has been a key aspect of agriculture for over 5,000 years and has been devel ...

, and rabies prophylaxis.

Complications

Common complications from penile injury are erectile dysfunction, abnormal penile curvature, penile abscess, formation of fibrotic plaques, painful erection, urethral stricture, uretherocutaneous or corporourethral fistula.{{Cite web, date=2019-11-09, title=Penile Fracture and Trauma: Practice Essentials, Background, Relevant Anatomy, url=https://emedicine.medscape.com/article/456305-overview, url-access=registration

References

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