Genital Trauma: Initial

Assessment and Management

dr. Indri Aulia, SpBP-RE(K), MPd.Ked
Plastic Reconstructive and Aesthetic Surgeon
External Genitalia Section
RSUPN Cipto Mangunkusumo
 Trauma

Source: Orawee Chinthakanan

 Concern

Fears of Loss of Loss of

Pain Function Life
Male
Anatomy
 Cause
Combat

Ritual Process

Vehicle Accident

Farm Machinery

Self-emasculation

Hallucination
 Signs

Butterfly Scrotal
hematoma Infection
+- Urinary
extravasation

Bloody Discharge
Radiology and Laboratory Examination

To find genitourinary
trauma (pyelography,
cystography)
Purpose
To aggressively
diagnose
 Gene ral Treatment
Pelvic
Injury
Intra-
abdominal Primary
Injury
Survey
→C Output
Monitoring →
Urethra?
 Urethral Injury

Posterior • Suprapubic catheter

• Definitive reconstruction: 4-6 months later
Part
Anterior • Urine diversion →Suprapubic/urethral
catheter
Part • Definitive reconstruction: 4-6 months later

Only by competent surgeons

 C a t e g o r y
Culp, 1977

Non-
Penetrating Avulsions Burns Radiation
penetrating
 Internal damage
Sudden
without skin
deforming forces
disruption → USG
Non-
penetrating
Injury
Rule out urethral Contusions →
injury First Aid
 Bed rest

Ice packs

First Aid for Analgesia

Non-
penetrating
Injury Inured area elevation

Oral enzyme
 Dartos fascia Buck’s fascia
disruption → disruption → simple
urethral injury penile contusion
Types of
Non-
penetrating Tunica
Injury albuginea/corpora Corpus spongiosum
cavernosa disruption disruption → rare
→ penile fracture

Disruption → hematoma → fibrosis → penile deformity

 Immediate Hematoma
Debridement
Exploration Evacuation

Treatment Anatomic +- Adequate

Drainage
for Non- Repair urine diversion
penetrating
Injury

Bandage
 Often involve Extreme blood
urethra loss

Amputee
Psychiatric care
Penetrating preservation
Injury

Gunshot -
pelvic structure
stabilization
 Exploration - Foreign body
debridement removal

Revascularization /
Treatment Replantation - 16
Anatomic Repair
for to 18 hours after
Penetrating trauma
Injury

Stump repair Drainage

How to Preserve Penile Amputee

Penetrating
Injury
 Penile Replantation

Penetrating
Injury

2 dorsal arteries

1 deep dorsal vein

Dorsal nerve

Penile parts
 Occurs in
Rotating
avascular plane
machinery
→ less bleeding

Avulsions
Injury

Rule out Perineal

urethral injury lacerartion
 Wound
Closure within +- Adequate
Debridement closure – skin
12 hours urine diversion
graft

Treatment
for
Avulsions
Injury

Revascularization Delayed
Bolster Bandage
and replantation reconstruction
 Same with
other burns
injury

Chemical
injury →
Irrigation Burns
Electrical injury
→ systemic
observation
 Burns Urine
management monitoring
Treatment
for Burns
Urine Injury
Debridement
diversion
 Radiotherapy –
Mandatory
effective for2-3 cm
circumcision
superficial lesion

Radiation
Injury
Chronic Skin necrosis and
lymphedema gangrene
 Excise
Debridement edematous
tissue
Treatment
for
Radiation
Skin graft / Injury
flap
 Other Zipper Injury Circumcision
Injuries
Female
 Anatomy

Gross anatomy of the female external genitalia

Source: Orawee Chinthakanan
 Superior view of
the pelvic floor muscle

Perineal membrane
and perineum

Source: Orawee Chinthakanan

 Bleeding Identification
control of orifices
Vulvar
Injury Urine
diversion
 Penetrating Bleeding
injury control
Labia
Minor
Injury Anatomical
restoration
 Labia Minora Morphology

Banwell classification

Source: Orawee Chinthakanan

 Belief and
Rape
Religion
Hymen
Injury Anatomical
restoration
 Hymenoplasty

Female Genital Plastic and Cosmetic Surgery, First Edition. Edited by Michael P. Goodman.
 Bleeding Control →
Penetrating Injury
Tampon

Vaginal
Vaginal
Injury Pelvic floor reconstruction →
restoration immediate / delayed
reconstruction
 G oals
Looks appropriate

Reduce physical discomfort

Reduce mental discomfort

Enhance sexual healing

E t h i c a l C o n s i d e r a t i o n

Non-maleficence Justice
• Informed consent • Relieve patient’s
• Screening of • Minimize complaints • Treat the patient
psychological complications • Explore the fairly
disorders motivation

Autonomy Beneficence
40

Thank You