Penetrating External Genital Trauma: A 30-Year Single Institution Experience

Abstract

We examine the characteristics, outcomes and incidence of penetrating external genital trauma at our level I trauma center. Patient records entered into our urological trauma registry were reviewed from 1977 to August 2006. A total of 110 patients sustained penetrating external genital trauma. Injuries were divided into gunshot wounds (49%), stab wounds/lacerations (44%) and bites (7%). Half of the stab wounds/lacerations were self-emasculation injuries. Operative exploration was performed in 78%, 63% and 75% of gunshot wounds, stab wounds/lacerations and bite injuries, respectively. Of 6 patients with complete penile amputations 5 underwent replantation with an 80% success rate. Testicular injury occurred in 39% and 27% of patients with gunshot wounds and stab wounds/lacerations, respectively. Of the 24 testicles injured via gunshot wounds 18 were reconstructed (75%). Testicular salvage rates were 24% (4 of 17) for self-emasculation stab wounds and 20% (1 of 5) for all other stab wounds/lacerations injuries. Of patients with penetrating external genital trauma 11% also had associated urethral injuries. The incidence of penetrating external genital trauma has remained stable during the last 30 years (r(2) = 0.98). Of patients treated with operative exploration 8% and of those treated nonoperatively 4% reported complications. Conservative débridement of penetrating injuries to the external genitalia should be stressed to maximize tissue preservation. Testicular salvage rates are significantly higher in gunshot wound injuries (75%) compared to stab wounds/lacerations injuries (23%) (p <0.001). A select group of patients with penile and scrotal injuries (ie those with injuries superficial to Buck's or dartos fascia) may undergo nonsurgical treatment of the penetrating external genital injury with minimal morbidity.