External Genitalia Injury Research Articles

Urologic Trauma Management for Military Providers.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Factors affecting female external genital findings in child sexual assault victims

ABSTRACT The presence of external genital findings in child sexual assault victims is frequently not in accordance with the history of the incident acknowledged by the victims, due to many factors that can affect those findings. This study aimed to identify various factors affecting the findings of external genitalia injuries in child sexual assault victims. Clinical data were collected from medical records and then analysed statistically. Hymenal and/or non-hymenal injuries were observed in 64.2% of all subjects. Hymenal tears in all regions were significant for penile penetration. Factors affecting hymenal injuries were age group, nature of sexual violence, and number of penetrations. Factors affecting non-hymenal injuries were the nature of sexual violence and the time of examination.

A Hard Day at Work: An Analysis of Occupational Genitourinary Injuries in the United States Workforce

ObjectiveTo use national data to identify risk factors for occupational genitourinary (GU) injuries and to expose potential workplace safety issues requiring national regulation. Materials and MethodsThe National Trauma Data Bank was queried to identify all adults who suffered a work-related GU injury from 2007 to 2016. Injury was stratified by individual organ and by organ type: intra-abdominopelvic (IAP) vs external genitalia (EG). Distinct multivariable logistic regression models were used to examine associations between prespecified risk factors and GU injury (organ and type) and to identify predictors of intensive care unit and operating room (OR) transfer. ResultsTwo thousand one hundred thirty-nine patients (total of 2681 GU injuries), were included. A mean of 1.3 GU organ injuries and 7.6 total injuries were suffered per patient. 72% suffered an IAP GU injury, 23% an EG injury, and 5% suffered both. Patients working in agriculture/forestry/fishing, (OR 2.3, P = .003), manufacturing (OR 1.9, P = .05), and natural resources/mining (OR 2.3, P = .012) were at significantly increased risk of EG injury. The penis and urethra were particularly at-risk in agriculture/forestry/fishing (OR 4.0, P = .005; OR 3.0, P = .002) and the urethra in natural resources/mining (OR 3.4, P = .004). IAP GU injury was a significant predictor of intensive care unit transfer (OR 1.8, P <.001), whereas EG injury was a significant predictor of OR transfer (OR 2.5, P <.001). ConclusionOccupational GU injuries remain a major issue for blue-collar workers. External genitalia are particularly at-risk, and injuries often require emergent surgery. National occupational health agencies need to continue to enhance on-the-job safety for those at-risk.

Bilateral Testicular Evisceration Sequel to Trauma: Challenges of Management in Emergency Department

Introduction The Genitourinary (GU) tract injury is rare with an annual incidence of less than one percent. We present a rare case of traumatic degloving injury of male external genitalia with complete evisceration of bilateral testicles following motor vehicle accident. Case description 29-year-old lorry driver was brought to Emergency department following head-on crash of his lorry into a ravine resulting in chest, abdomen and pelvis slamming onto dashboard. The driver was trapped for 4.5 hours. On arrival, he was conscious but hemodynamically unstable. Clinical examination and Focused Assessment with Sonography in Trauma (FAST) was suggestive of left pneumothorax and no evidence of intraabdominal injury. Chest tube was inserted. Genital examination showed scrotal degloving wound with complete evisceration of bilateral testis. He also sustained open fracture of right tibia, fibula and left inferior pubic rami fracture. Upon stabilization, was sent for operation and intraoperatively found to have bilateral testicular rupture. He underwent scrotal exploration, and bilateral orchidopexy. Postoperatively, multiple dialysis sessions were done for rhabdomyolysis. Hormonal study yielded low levels of testosterone. He was discharged home after 2 weeks with testosterone pills. Discussion Challenges in Emergency Department setting would be prompt identification and management of life-threatening injuries along simultaneous management of degloving external genitalia injury and associated injuries. FAST and extended FAST play a key role in managing life threatening conditions. Conclusion Total evisceration of bilateral testis injury are rare. Although not life threatening, should be treated promptly and thoroughly in order to avoid long-term functional and psychological damage.

Characteristics of Traumatic Urogenital Injuries in Emergency Department; a 10-year Cross-sectional Study.

Urogenital system injuries (UGIs) are seen in 10% of adult cases with multiple trauma. Although UGIs are rarely life threatening, they can cause major long-term morbidities. This study aimed to evaluate the characteristics of traumatic UGIs in patients who were referred to emergency department following multiple traumas. This retrospective cross-sectional study was conducted on multiple trauma patients who were presented to emergency department during a 10-year period (2008-2017). All patients with kidney, ureter, bladder, urethra, or external genitalia injuries were studied. The patients' data were extracted from their clinical profiles. Out of the 13598 admitted patients in our trauma center, UGIs were seen in 267 (1.9%) cases. The mean age of patients with UGIs was 27.3 ± 6.1 years (74.15% male). The highest incidence of UGI was seen in those aged between 21 and 30 years (39.7%) and motorcycle accidents (49%) was the most frequent cause of trauma. 221 patients had an unstable situation and were emergently transferred to operation room (13.57% with traumatic kidney injury). The most common injured sites of urogenital system were kidney with 155 (58%) cases, followed by external genitalia with 91 (34.1%) cases. 77.5% of cases were managed conservatively and the rest (22.5%) underwent surgical procedures. UGIs comprise a low percentage (2%) of traumatic injuries, which are mostly caused by blunt trauma due to road traffic accidents. Kidney is the most common injured organ and UGIs mostly happen in young ages.

Genitourinary injuries after traffic accidents: Analysis of a registry of 162,690 victims.

Traffic accidents are the most frequent cause of genitourinary injuries (GUI). Kidney injuries after trauma have been well described. However, there exists a paucity of data on other traumatic GUI after traffic accidents. The objective of this study was to analyze the frequency and type of all GUI, by user category, after traffic accidents. Patient cases were extracted from the trauma registry of the French department of Rhone from 1996 to 2013. We assessed the urogenital injuries presented by each of road user's categories. Severity injuries were coded with the Abbreviated Injury Scale and the Injury Severity Score. Kidney trauma was mapped with the classification of the American Association for the Surgery of Trauma. Multivariate prediction models were used for analysis of data. Of 162,690 victims, 963 presented with GUI (0.59%). 47% were motorcyclists, 22% were in a car, 18% on bicycles, and 9% were pedestrians. The most common organ injury was kidney (41%) followed by testicular (23%). Among the 208 motorists with a GUI, kidney (70%), bladder (10%), and adrenal gland (9%) were the most frequent lesions. Among the 453 motorcyclist victims with GUI, kidney (35%) and testicular (38%) traumas were the most frequent and 62% of injuries involved external genitalia. There were 175 cyclists with GUI, 70% of injuries involved external genitalia; penile traumas (23%) were the most frequent. In total, there were 395 kidney injuries, most being low grade. According to the American Association for the Surgery of Trauma kidney injuries were grade I, 59%; grade II, 11%; grade III, 16%; grade IV, 9%; grade V, 3%; and indeterminate, 2%. GUI is an infrequent trauma after traffic accidents, with kidneys being the most commonly injured. Physicians must maintain a high awareness for external genitalia injuries in motorcyclists and cyclists. Prognostic and epidemiologic study, level III.

Injury to the male external genitalia: a comprehensive review.

While rare, trauma and injury to the male external genitalia can result in significant consequences regarding function, appearance, psychological effects, and overall quality of life. Due to the relative paucity of literature regarding male external genitalia injuries, few standardized protocols exist. This review aims to outline common clinical causes of male external genitalia injuries by both anatomic location and etiology. Initial stabilization, long-term reconstruction, and coverage options are discussed in detail. Outcomes of complex grafts have favorable success rates of 90-100% in the hands of experienced surgeons. Outcomes of penile, testicular trauma also have favorable outcomes when managed appropriately. Attempts at reconstruction after initial injury stabilization should be undertaken at high-volume centers where a multidisciplinary approach can be employed. This manuscript will be an excellent reference and source that can provide direction for evaluation and management of these complex presentations.

Exploring Genitoanal Injury and HIV Risk Among Women: Menstrual Phase, Hormonal Birth Control, and Injury Frequency and Prevalence.

Genital, anal, and oral injuries sustained from sexual intercourse may explain HIV transmission among women. We determined the variability in genitoanal injury frequency and prevalence in women after consensual sexual intercourse, exploring the role of menstrual phase and hormonal birth control. We used a longitudinal observational design with a convenience sample of 393 women aged 21 years and older. Participants had a baseline interview with gynecological examination, followed by consensual sexual intercourse with a male partner and a second gynecological examination. We analyzed injury prevalence with logistic regression and injury frequency with negative binomial regression among women who were (1) menstrual, not using hormonal birth control, (2) menstrual, using hormonal birth control, or (3) menopausal. We also compared injury among menstrual women in the follicular, ovulatory, and luteal phases. Women using hormonal birth control had 38% more external genitalia injuries [adjusted rate ratio (ARR) = 1.38, P = 0.030] and more than twice the anal injuries (ARR = 2.67, P = 0.005) as the nonhormonal birth control menstruating group. Menopausal women had more than 3 times the anal injuries (ARR = 3.36, P = 0.020) than those in the nonhormonal menstrual group. Among menstrual women, those in the follicular phase had a greater prevalence and frequency of external genitalia injuries than those in other phases. Increased rates of postcoital genitoanal injuries are noted among women using hormonal birth control and/or in the follicular phase of menstruation. Biological factors that influence women's risk for HIV warrant further investigation.

Penile injuries: A 10-year experience.

We report our 10-year experience with penile injuries. We retrospectively reviewed the records of 156 cases of male external genitalia injuries between May 2002 and December 2012. Of these, only 26 patients presented without urethral injuries and were included in this study. Patients were divided into 4 groups: Group 1 (n = 12) with patients with penile fractures injuries; Group 2 (n = 5) with patients with penile amputation injuries; Group 3 (n = 2) with patients with penile penetrating injuries; and Group 4 (n = 7) with patients with penile soft tissue injuries. Grading of injury was done using the American Association for the Surgery of Trauma (AAST)-Organ injury scale of penile injury. Penile injuries without urethral injuries are urological emergencies which require immediate attention.

Health disparities in the forensic sexual assault examination related to skin color

Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.

Severe Case of Male External Genitalia Injury in a Poly-Traumatized Patient

We describe the case of a 34-year-old patient, polytraumatized during a motorcycle accident. The patient reported complete urethral rupture, bilateral avulsion of the testes by the scrotum, subtotal avulsion with complete amputation of the corpora cavernosa, and a deep open perineal wound. The reconstruction, performed by urologists, was postponed to the following day to ensure high standard of treatment with appropriate tools. This choice has yielded a good aesthetic and functional result.

Penetrating trauma to the external genitalia in Operation Iraqi Freedom

This report details the incidence and description of trauma to the external genitalia experienced during Operation Iraqi Freedom at a United States Army Combat Support Hospital, and demonstrates that acceptable rates of testicular salvage are possible in the combat setting. The operating room logs and the Joint Theater Trauma Registry were used to conduct a retrospective review of the patients who sustained genitourinary (GU) injuries at an US Army Combat Support Hospital (CSH) in Iraq from 27 February 2007 to 14 August 2007. Of the 3595 battle trauma injuries seen at the CSH during the time period, 168 (4.7%) had one or more GU injuries for a total of 172 GU injuries. Of these patients, 115 (68%) with GU injuries had one or more injuries to the external genitalia for a total of 119 external GU injuries. Penetrating trauma to the penis and scrotum accounted for 59 of the injuries. In total, 43 testicles were injured in 34 patients (9 had bilateral injuries). In total, 32 testes were repaired primarily and 11 were removed. Injuries to the external genitalia continue to account for the vast majority of GU trauma in a combat setting. Of patients who presented with penetrating testicular trauma, there was a 74.4% salvage rate, which is higher than previous reports of combat external genitalia injuries. Treatment of penetrating trauma to the external genitalia in a combat setting requires attention to tissue preservation while coordinating associated surgical procedures.