Injuries to the scrotum and penis

Trauma to the penis is called damage to

an organ, characterized by complete or
partial disruption of its functionality. It
may involve muscles, skin, tunica
albuginea, spongy and cavernous
bodies, and subcutaneous tissue of the
penis .
Penile injuries account for the vast majority of cases—
approximately 50% of all identified genital injuries.
However, only in 2% of cases the injury affects both
testicles. Most often in this situation, the corpora
cavernosa, glans and foreskin are affected. This
pathology is characterized by a pronounced pain
syndrome and subsequently causes erectile
dysfunction or even infertility.
 Types of penile injuries
Classification of penile injuries is carried out according to the presence or absence of
violations of the integrity of the skin.

open closed .

Open injuries to the penis are less
common and include frostbite, burns,
bites, stab wounds and gunshot
wounds. In addition, there are cases
of traumatic penectomy (amputation
of the penis).
Closed injuries of the penis are
characterized by damage to the
internal structures of the organ
resulting from mechanical impact.
In this case, no violation of the
integrity of the skin is observed.
 Closed penile injuries

dislocation of the penis fracture pinching of a bruise of

penis member the penis;

such damage can occur

such an injury due to bending of the ;the injury is associated
occurs when the organ in an erect state; This is
with pulling the shaft of
root of the organ a fracture of the penis the most
the penis with an elastic
is displaced into occurs most often common
band, thread or other
the area of ​the during rough sexual injury
constricting object;
scrotum, pubic intercourse; it is caused by
often these arise due to
symphysis or characterized by a direct
the fault of a man who
perineum; in this serious damage to the blow.
wants to maintain an
case, the fixing urethra and corpus erection or get rid of
ligaments spongiosum; urinary incontinence
rupture;
 Symptoms of penile injuries

Symptoms of penile injuries vary and directly depend on the

type and severity of the injury. There are several common
symptoms characteristic of any form of pathology:

*swelling and hematomas;

the appearance of blood or blood clots in the urine;

difficulty urinating;

pain syndrome of varying severity;

bleeding from an open injury;

bloody discharge from the urethra without urination (urethrorrhagia)

Bruises are characterized by severe pain, swelling and bruises.
When a fracture occurs, the erection immediately disappears,
and an extensive hematoma develops over the entire area of ​
the penis. With dislocation, the displacement of the root of the
organ into the scrotum or perineum is visually noticeable. In
case of open injuries, severe pain in urination is felt, and tissue
damage is clearly visible visually. These are just some of the
symptoms that occur most often. For a more in-depth
description, it is necessary to consider each type of injury
separately.
 Causes of penile injuries

Trauma to the male genital organ can be caused by any

mechanical force. Penis pinched by a zipper, dislocations or
fractures due to bending of the erect organ during sexual
intercourse are common. In traumatology, cases of penetrating
wounds are not uncommon, the cause of which can be bites,
gunshot wounds or damage from a cutting object. Penile
amputation is usually associated with criminal acts or cases of
self-harm associated with mental illness.
 Diagnosis of penile injuries

To diagnose a penile injury, you must immediately

contact a traumatologist, surgeon or urologist and
undergo an examination. It begins with a history taking
and examination of the genitals. When interviewing the
patient, special attention is paid to the factors that led to
damage to the penis.
As a rule, only an external examination is sufficient to make a
diagnosis, since many symptoms are pronounced and visible
to the naked eye. To determine the severity of the injury, it
may be necessary to conduct an ultrasound of the penis and its
vessels, as well as cavernosography (X-ray of the cavernous
bodies with preliminary administration of a contrast agent)
and MRI. To exclude or confirm damage to the urethra,
urethroscopy may be prescribed.
 Treatment of penile injuries

The choice of treatment method for penile injuries depends on the

type of injury and its severity.

conservative therapy surgery

 Conservative treatment

Treatment for common penile contusions is

treated with watchful waiting. The patient is
recommended to rest completely and apply cold
compresses for the first two to three days after
injury. Non-steroidal anti-inflammatory drugs
are used to reduce pain.
 Surgery
If you receive an open injury to the penis, first of all, the wound on the
genital organ is immediately treated, damaged tissue and foreign objects
are removed. After this, if necessary, the damaged skin is sutured and an
antiseptic bandage is applied.

If, during the treatment of a bruise, the development of extensive

hematomas is detected, surgical removal of blood clots and subsequent
restoration of the damaged tunica albuginea are mandatory.
Approximately the same measures are carried out in case of a fracture.
Dislocation of the penis is treated by opening it and realigning it,
followed by suturing the torn ligaments. This involves fixing the penis to
the pelvic bones. Treatment of damage to the urethra requires plastic
surgery, which is necessary for the normal passage of urine and sperm.
In case of complete amputation of the penis, surgeons connect the tissues
layer by layer to restore their integrity. This intervention is possible only
if the organ was found and promptly delivered to a medical institution. In
other cases, penile prosthesis is performed.
 Rehabilitation

With minor injuries to the penis, the patient quickly recovers

and returns to his usual lifestyle. If an open injury has
occurred and/or surgery has been performed, the recovery time
depends on the severity of the initial condition and the extent
of the operation. The patient spends 1-7 days in the hospital. If
the urethra is damaged, a catheter is installed into it, which
ensures the passage of urine.
If necessary, doctors prescribe anti-inflammatory
drugs and antibiotics to prevent complications.
After discharge, the patient must carefully follow
the doctor’s recommendations: refrain from
visiting baths and saunas, intimate contacts, and
physical activity. Clothing, including underwear,
should not tighten the scrotum. It is necessary to
choose models from natural, breathable fabrics.
To monitor healing, the urologist will schedule
routine visits to the clinic.
 Injuries to the scrotal organs

anatomical or functional damage to the male genital organs located in the

scrotum, resulting from exposure to external mechanical, chemical, temperature,
electrical and other factors. In the structure of injuries to the genitourinary
system, injuries to the scrotal organs occupy about 25%. Among the victims, 80%
are young and middle-aged patients. In urology and andrology, injuries to the
scrotal organs are often combined with injuries to the penis.
 Classification of scrotal injuries

Based on the nature of the injury (the presence of a

violation of the integrity of the skin), closed (blunt,
subcutaneous) and open injuries are distinguished. Both
groups of injuries can occur without damage to the
scrotal organs or with their involvement (damage to the
testicle, epididymis, spermatic cord). Closed injuries
include bruising and pinching of the scrotum. In
peacetime, closed injuries to the scrotum are 6-8 times
more common than open ones.
According to the etiology, open injuries to the organs of the
scrotum can be punctured, cut, bitten, gunshot (blind or
through, bullet or shrapnel, with or without a foreign body in
the scrotum), etc. A particularly severe type of open injury is
traumatic amputation of the scrotum. Depending on the
presence or absence of a combination with injuries to other
organs, injuries to the scrotum can be isolated or combined.
Most often, injuries to the scrotal organs are combined with
injuries to the urethra, bladder, rectum, pelvic bones, and soft
tissues of the thighs, which requires the involvement of not
only urologists, but also proctologists and traumatologists in
their treatment.
 Causes of injuries to the scrotal organs
Blunt injuries to the
scrotum account for almost
80% of all cases of injuries
to this anatomical region.
The immediate causes of
closed injuries to the
scrotum and its organs are
beatings, road accidents,
injuries at home or at work,
during sports (martial arts,
cycling, horse riding, etc.)
Most often, closed injuries are the
result of a direct blow to the
scrotum. A damaging factor can be
compression of the scrotum during
sexual intercourse, rubble in
mines, accidents, earthquakes and
other disasters. Chronic injuries to
the scrotal organs associated with
vibration, shaking, overheating can
lead to impaired spermatogenesis
(oligospermia, asthenozoospermia,
azoospermia).
 Thermal injuries to the scrotal organs can include burns from boiling
water, steam, hot objects, chemicals, and frostbite. Knife and gunshot
wounds leading to open trauma to the scrotal organs occur in 5% of
cases. Bite injuries can be caused by both animals and a sexual partner.
 Symptoms of scrotal injuries
Closed scrotal injuries

With closed injuries, the scrotal organs may remain intact or be damaged to varying
degrees. Injuries include bruises, dislocation and rupture of the testicle and
epididymis, and injuries to the spermatic cord. The looseness of the connective tissue
and the abundant vascularization of the scrotum contribute to the fact that closed
injuries in almost all cases occur with the formation of hematomas. Hemorrhages in
the scrotum can be superficial or accompanied by massive hemorrhagic infiltration,
spreading to the tissue of the penis, perineum, anterior abdominal wall, and inner
thighs.
As a result of bruising, the scrotum becomes purplish-
blue, sometimes blue-black, and significantly
increases in size on the side of the injury. Closed
injuries of the scrotal organs (especially the testicle
and epididymis) are characterized by acute intense
pain, often by symptoms of painful shock. When the
testicular membranes rupture, intravaginal hemorrhage
occurs - hematocele; the scrotum is tense, the testicle
is not palpable. With dislocation (dislocation of the
testicle), it may be torsion in the area of ​the spermatic
cord or displaced (false cryptorchidism). Testicular
dislocation can be inguinal, pubic, perineal, or
abdominal.
 Closed injuries to the spermatic cord are rare because this
anatomical structure is well protected. Usually, when
damaged, there is a bruise of the spermatic cord,
compression by a large hematoma. Due to damage to the
scrotal organs, post-traumatic orchitis and epididymitis,
phlegmon and gangrene of the scrotum, atrophy of the
testicular parenchyma and infertility can develop. Injuries to
the scrotum significantly increase the risk of developing
testicular cancer.
 Open scrotal injuries

Open injuries to the scrotum in almost all cases are

accompanied by traumatic shock. Characterized by severe pain
and bleeding (both external and internal). When the spermatic
cord is injured, bleeding from the wound can be very
dangerous. The victim may be in a state of collapse or
fainting. Objectively, adynamia, pallor and moisture of the
skin, weak rapid pulse, and arterial hypotension are
determined. Due to swelling and imbibition of loose tissue by
blood, the scrotum increases in size.
 With gaping wounds of the scrotum, testicular prolapse may
occur. Open injuries to the scrotum can lead to injuries to the
tunica albuginea, separation of part of the testicle, its
fragmentation, complete separation, and damage to the
epididymis. Traumatic amputation of the scrotum occurs with
symptoms of traumatic shock and severe blood loss. In the
perineal area there is a wound with remnants of the skin of the
scrotum and bleeding vessels of the spermatic cord.
 Diagnosis of scrotal injuries

Traumatic damage to the scrotal organs should not

be ignored by a urologist, andrologist, surgeon, or
traumatologist, since the reproductive and general
health of a man depends on the completeness of
diagnosis and medical care. The preliminary type of
injury and the degree of damage are established on
the basis of complaints, anamnesis, examination
and palpation of the scrotum.
The method of primary instrumental examination is ultrasound
of the scrotal organs, which makes it possible to diagnose
hematocele, concussion or rupture of the testicle, and the
presence of a foreign body in the tissues of the scrotum.
Ultrasound scanning of the scrotal vessels allows one to assess
testicular perfusion and detect vascular damage. To recognize
the nature of closed injuries, informative MRI. Intravaginal
hematoma must be distinguished from hydrocele (hydrocele).
Since puncture of the testicular membranes in case of injury is
extremely undesirable, it is advisable to use diaphanoscopy of
the scrotum for differential purposes.
 Treatment of scrotal injuries Treatment of scrotal injuries can
be conservative or surgical. For uncomplicated injuries of the
scrotum, symptomatic therapy is carried out (anti-
inflammatory, antibacterial, painkillers, hemostatic agents). In
the first hours after injury, local cooling of the scrotum and
immobilization by applying a pressure bandage or suspensor
are indicated. After 3-4 days, to speed up the resorption of
subcutaneous hemorrhages, thermal physiotherapy procedures
are prescribed: Sollux, ultra-high-frequency therapy, paraffin
therapy.
 In case of dislocation, closed manual or surgical reposition of
the testicle is performed, which, if necessary, is supplemented
by subcutaneous orchiopexy. In the presence of extensive and
deep post-traumatic hematomas, they are drained. An open
revision of the scrotal organs makes it possible to remove non-
viable tissue, suturing ruptures, performing testicular
resection, or, if indicated, performing an orchiectomy or
epididymectomy, and lowering the testicle into the scrotum.
 Open injuries require primary surgical treatment of
wounds of the scrotum, opening of the testicular
membranes, removal of the hematoma, stopping
bleeding; conducting an audit of the testicle,
epididymis and spermatic cord. Depending on the
damage detected, the integrity of the vas deferens may
be restored or ligated, or the testicle or epididymis
may be removed.
 When the scrotum is torn off while preserving
the testicles hanging on the spermatic cords,
they are immersed in specially formed “pockets”
under the skin of the thigh, and after a few
weeks they are transferred to the scrotum
formed from a skin flap. Patients with traumatic
amputation of the testicles are indicated for
testicular transplantation or implantation of an
artificial testicle. For bite wounds, patients are
given a rabies vaccine; for other open lesions -
antitetanus and antigangrenosis serum.