Major Traumatic and Septic Genital Injuries

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Abstract
Major injuries to the testicles, penis and genital skin from trauma and infection were seen in 62 patients over a 6-yr period (1977-1983). Urethal injuries were excluded. In the past blunt testicle injuries were infrequently diagnosed and surgically ignored because of large surrounding hematomas. With the use of real-time ultrasound, 17 of 18 cases of testicle rupture were correctly diagnosed preoperatively. Surgical repair resulted in testicle salvage in 16 patients. Penetrating testicle injuries resulted in a high orchiectomy rate secondary to the infrequently described but recognized entity of self-emasculation in transsexuals. Penile rupture from blunt injuries (8) was successfully repaired and complete function was recovered. Penetrating penile injuries (4) were extensive and involved the urethra in 2 cases; full function returned after reconstruction. Major skin loss of the penis and/or scrotum (19) occurred from necrotizing fascitis, burns, avulsion and penetrating injuries. Early debridement, bowel and urinary diversion followed by penile skin grafting, thigh pouches to protect testicles and scrotal reconstruction resulted in acceptable cosmetic and functional results in all cases of major skin loss.