Gunshot wounds to the penis

Gunshot wounds to the penis are a relatively common type of military injury and are usually severe. Gunshot wounds to the penis are very rare in peacetime. In wartime, about 82.2% of penile injuries are mine-explosive. The degree of damage depends on the caliber, speed, and mass of the bullet.

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Epidemiology

Due to the great technical progress in the production of mine-explosive devices, injuries to the external genitalia from this type of weapon have become more frequent and severe. Bullets, shell fragments and mines, hitting various parts of the penis, can damage all its anatomical structures and even lead to amputation of the penis.

In wartime, gunshot wounds to the penis are more common and account for 14.7% of gunshot wounds to the genitourinary system. Isolated gunshot wounds are extremely rare and in most cases are not life-threatening. At the same time, combined wounds, especially mine-explosive trauma, cause severe and extremely severe conditions of the wounded upon admission to the stages of qualified medical care in 32.4 and 12.1% of cases, respectively. A wound to the penis is most often combined with damage to the urethra (77%) and scrotum (50%).

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Symptoms of a gunshot wound to the penis

Gunshot wounds to the penis are accompanied by bleeding corresponding to the size of the wound and the depth of tissue damage. It is always significant in the case of massive damage to the cavernous bodies. Against the background of profuse bleeding, urination disorders occur; in the case of blind gunshot wounds, foreign bodies often remain in the penis, causing acute pain during erection.

Stab wounds can be caused by sharp weapons. The clinical course depends on the degree and depth of the injury.

The elasticity and contractility of the penis skin is the reason why, with a tangential wound, the skin with subcutaneous tissue is damaged and when it is straightened, a gaping wound of considerable size is revealed, creating the impression of extensive and serious damage. Such a wound is characterized by profuse bleeding from the superficial network of large veins. After ligation or coagulation of the vessels, the integrity of the protein membrane is determined.

Abundant blood supply to the loose subcutaneous fatty tissue of the penis is the main reason for the formation of large hematomas that spread to the entire penis. Blood immobilizes the subcutaneous tissue, blocks the lymphatic vessels, resulting in pronounced swelling of the skin, which often takes on a blue-purple color.

After 3-5 days from the injury, the altered tissues, which are externally non-viable, acquire a pink color, and the hematoma gradually resolves, limited necrotic areas of the skin and subcutaneous tissue are rejected, and the wounds become covered with granulation.

In case of open injuries of the penis, urination is usually painful, and sometimes acute urinary retention develops, which is typical for injuries of the urethra. In these cases, urinary infiltration of the underlying tissues may also develop. In addition, acute cavernitis may develop soon after the injury.

Late complications include skin cicatricial adhesions that fix the penis in a vicious position and cicatricial changes in the cavernous bodies that deform the penis and disrupt its erection. But the most significant late complications in the case of damage to the urethra include strictures of the urethra.

In case of open damage to the cavernous bodies, the most abundant, life-threatening bleeding and shock develop. In such cases, partial or complete amputations of the penis often occur, which can be restored by microsurgery.

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Treatment of a gunshot wound to the penis

Before the operation, the amputated segment is stored in a container with sterile saline solution, which is placed in ice water (maximum storage time is 16 hours).

The principles of surgery for a gunshot wound to the penis are as follows:

• The urethra is sutured in two layers on a catheter (this makes it possible to fix the penis for further vascular development).
• Minimal dissection is performed along the neurovascular bundle to differentiate large vessels and nerves.
• The protein wall is sutured with 4/0.0 absorbable threads.
• A microsurgical anastomosis of the dorsal artery is performed using 11/0 nylon sutures.
• The dorsal vein is reconstructed with 9/0 nylon sutures.
• The dorsal nerve of the penis is reconstructed epineurally using 10/0 nylon sutures.
• A suprapubic cystostomy is installed.

The results of microsurgical reconstruction are surprisingly good, the most common disorder is a disturbance of the sensitivity of the skin of the penis (90%).

If reimplantation is not possible, penile resection is performed, during which the cavernous bodies are closed and a new external opening of the urethra is formed. Penile stump lengthening surgeries with and without implants are also offered.

When one of the cavernous bodies is crossed, the penis is typically bent in the opposite direction. Injuries to the head of the penis, which can occur, in particular, during ritual circumcisions, vary in severity, up to and including its complete amputation.

When the penis gets into moving mechanisms, usually through clothing, extensive scalped wounds that extend to the scrotum often occur, accompanied by intense pain and even traumatic shock. Significant bleeding is not uncommon. In this case, a complete tear of the skin of the scrotum and penis is possible. In this case, a large skin defect is formed, which is mainly associated with treatment problems. It is important to deliver the scalped skin to a medical institution, otherwise the defect on the penis is covered with the skin of the anterior abdominal wall, and the testicles are immersed under the skin of the thighs. Otherwise, a purulent infection may occur, and subsequently persistent curvature of the penis and the absence of a normal erection.