Editorial Comment

Abstract

Genital burns are bad for you. This has serious implications for the burn patient and their surgeons. When I read a report such as this, I try to absorb all the salient facts, to add them to my “gestalt”. The next time I am facing a genital burn, I know what I am up against. This is what I learned from the report: -Genital burns increase the chance of a hospital-acquired infection by 300% and increase mortality by 50% (see: “genital burns are bad for you”). -Most (90%) patients with genital burns never need urogential surgery, but when required, the mortality rate is a very high 10% (20% mortality in the rare 1% who need “extensive” genital repair) (see: “genital burns are bad for you”). -Surgery, when you decided to do it, can have complications in excess of the high mortality rate: 20% require subsequent genital contracture repair. -Try to treat burns without surgery at first, assuming there are no absolute indications for genital burn surgery (such as mixed necrotizing infection, extensive tissue necrosis mandating tissue removal and coverage, and so forth). This is a tiebreaker for the literature, which advocates both surgical 1 McAninch J.W. Kahn R.I. Jeffrey R.B. et al. Major traumatic and septic genital injuries. J Trauma. 1984 Apr; 24: 291-298 Crossref PubMed Scopus (72) Google Scholar and nonsurgical 2 Peck M.D. Boileau M.A. Grube B.J. Heimbach D.M. The management of burns to the perineum and genitals. J Burn Care Rehabil. 1990 Jan-Feb; 11: 54-56 Crossref PubMed Scopus (36) Google Scholar approaches to most genital burns. (I worked under both senior authors in these opposing-view articles and am grateful to break the deadlock.) -Do not avoid surgery in that special subset of patients with extensive third-degree flame burns or deep electrical burns to the genitals: excise and graft these patients' genital burns as soon as the patients are medically stable – just similar to in any other body area. -Remove Foley catheters early in burn patients. If you cannot because of genital burn injuries, place a suprapubic tube if at all feasible. Genital Burns in the National Burn Repository: Incidence, Etiology, and Impact on Morbidity and MortalityUrologyVol. 83Issue 2PreviewTo better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. Full-Text PDF ReplyUrologyVol. 83Issue 2PreviewGenital burns can be bad indeed. As described in our article and re-emphasized in the editorial by Dr. Santucci, who has surgically summarized the important points of the study, genital burns are also unique, as mortality and infection rates were found to be significantly higher in this population. At our institution, we believe that initial conservative management, with vigilance for early infection identification and early genital grafting, are keys to successful outcomes. In other words, we do not necessarily treat these burns any differently than burns in other areas of the body, simply because of the “sensitive” nature of the anatomy. Full-Text PDF