Guidelines
Guidelines Summary
The American Urology Association (AUA) guidelines for diagnosis and management of genitourinary injuries were amended in 2017 and 2020 to reflect literature that was released since the original publication in 2014. Key recommendations for genital trauma include the following [27] :
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Penile fracture should be suspected in a patient who presents with penile ecchymosis, swelling, and pain following a cracking or snapping sound during intercourse or manipulation and immediate detumescence.
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Surgeons should perform prompt surgical exploration and repair in patients with acute signs and symptoms of penile fracture.
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Ultrasound may be performed in patients with equivocal signs and symptoms of penile fracture.
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Evaluation for concomitant urethral injury should be performed in patients with penile fracture or penetrating trauma who present with blood at the urethral meatus, gross hematuria, or inability to void.
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Surgical exploration and limited debridement of non-viable tissue should be performed in patients with extensive genital skin loss or injury from infection, shearing injuries, or burns (thermal, chemical, electrical).
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Prompt penile replantation should be performed in patients with traumatic penile amputation, with the amputated appendage wrapped in saline-soaked gauze, put in a plastic bag, and placed on ice during transport.
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Initiate ancillary psychological, interpersonal, and/or reproductive counseling and therapy for patients with genital trauma when loss of sexual, urinary, and/or reproductive function is anticipated.
The European Association of Urology guidelines for urologic trauma were first published in 2003 and have undergone annual assessment of newly published literature in the field to guide updates. As of 2021, key recommendations include the following [8] :
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Penile fracture is associated with a sudden cracking or popping sound, pain, immediate detumescence, and local swelling.
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Magnetic resonance imaging (MRI) is the preferred imaging modality for the diagnosis of penile fracture.
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If a concomitant urethral injury is suspected, flexible cystoscopy is preferred over retrograde urethrography.
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Surgical closure of the tunica should be carried out using absorbable sutures within 24 hours of presentation.
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Nonoperative management is recommended for small superficial penetrating injuries with intact Buck’s fascia.
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In more significant penetrating penile injuries, surgical exploration and debridement of necrotic tissue should be performed.
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Surgical re-implantation should be considered and performed within 24 hours of amputation.
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If the severed penis cannot be found, or is unsuitable for re-attachment, then the end should be closed as it is done in partial penectomy.
Media Gallery
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Eggplant deformity.
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Small penile fracture involving the right corpus cavernosum.
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More severe penile fracture.
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Gunshot wound to the penis.
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Partial penile amputation.
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Repair of partial penile amputation after primary closure (without replantation of penile remnant).
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Penile amputation in the initial stage of replantation.
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Penile amputation after replantation.
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Presentation of superficial vascular injuries can be similar to penile fracture. Courtesy of Joel Gelman, MD.
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Ligation of the injured superficial dorsal vein upon exploration. Courtesy of Joel Gelman, MD.
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Concomitant urethral injury with visible Foley catheter.
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