Treatment of swelling of the penis
Injuries to the penis - Different in origin and severitydamage to the skin, spongy and cavernous bodies, subcutaneous tissue, fascia, muscles and the penile membrane of the penis. Symptoms of penile trauma depend on the type of injury and can include swelling, pain, bleeding, bruising, hematuria, urination disorders. Injuries of the penis are diagnosed on the basis of data of anamnesis, examination, palpation, ultrasound. The first help in trauma to the penis is to stop bleeding, erection of the wound, removal of foreign bodies; further tactics are determined by the type and severity of the damage.
Injuries of the penis - damage to the integumenttissues and internal structures of the penis, arising when exposed to mechanical and thermal factors. Damage to the penis makes up 2.2% of all injuries and 30-50% of injuries to the genito-urinary organs. Approximately 1% of the cases of damage are combined with traumas of the scrotal organs. Most often, penile lesions occur in men aged 15-40 years. In urology and andrology, penile trauma is an urgent pathology and requires urgent surgical care.
Classification of injuries of the penis
First of all, damage to the penisare divided into closed (80%) and open (20%). To the closed (blunt) injuries include bruises, infringements, dislocations and fractures of the penis. Open (penetrating) injuries include superficial, scalp, bitten, gunshot, stab-cut wounds of the penis. In addition, in traumatology patients with burns are often found. frostbites. traumatic amputation of the penis (pectectomy). Injuries of the penis can be both isolated and combined with damage to the organs of the scrotum, bones and pelvic organs.
Depending on the degree of severity, the European Urological Association distinguishes the following types of lesions of the penis:
- I degree - damage to integumentary tissues, contusion of the penis
- II degree - damage to the fascia of the beech surrounding the spongy and cavernous bodies
- III degree - tearing of the tissues (glans penis, urethra, cavernous body) with a defect length of less than 2 cm
- IV degree - rupture of the urethra, cavernous body with a defect in excess of 2 cm; partial amputation of the penis
- V degree - Complete traumatic amputation of the penis.
Types of injuries of the penis
Bruises are the most common typetrauma to the penis. Most bruises occur with direct bumps during sports and fighting, riding a bicycle, etc. Light bruises of the penis are accompanied by painful sensations, subsiding within 10-15 minutes after the stroke. For more severe injuries of the penis, accompanied by tearing of the gallbladder shell, pain, swelling of the penis, formation of subcutaneous hematoma are characteristic. imparting a bluish-and-purple color to the penis, difficulty walking, impaired urination. Strong sighting strikes against the penis can lead to a fracture of the cavernous body and the development of internal bleeding. In this case, under the skin of the penis for 15 minutes can accumulate up to 0.5 liters of blood, making the penis grows huge and blue-black. The blood accumulating in the subcutaneous tissue extends to the pubis, scrotum and inner thigh. With severe trauma to the penis and severe blood loss, the development of traumatic shock is possible.
This trauma usually occurs when the skinpenis into the zip lock mechanism of the trousers. At the same time on the surface of the penis a small wound is formed, causing severe pain. Less often, the penis is inflicted by a tummy tuck, a rubber band, and various ring-shaped objects. These injuries can be caused by a child's prank, mental abnormalities or in order to maintain an erection, prevent urinary incontinence.
Infringement of the penis is accompanied by the development ofedema of the tissues and pain; When the urethra is compressed, acute urinary retention occurs. Prolonged circulation in the penis can lead to necrosis of the skin and gangrene of the penis.
Dislocation and fracture of the penis
Dislocation of the penis is a consequence of the ruptureligaments, with which the penis is fixed to the bones of the pelvis. With this type of injury of the penis, the cavernous bodies move under the skin of the thigh, perineum, scrotum, and the penis itself is palpated in the form of an empty skin sac.
Penile fracture in most cases occursduring coarse intercourse and is the result of a sharp bend of the erect penis. This trauma of the penis is accompanied by rupture of the cavernous bodies and can be combined with damage to the urethra and spongy body. Usually, at the time of fracture, a distinctive crackling is distinctly heard, which patients are compared to the crunch of broken glass. At the same time there is an attack of acute pain and an erection stops. The consequence of the beginning internal bleeding is the appearance and rapid growth of the hematoma, intensification of pain intensity, the phenomenon of shock. If the urethra is damaged, there is a delay in urination. Fracture of the penis - a dangerous type of injury, the long-term consequences of which can become infectious complications, curvature of the penis. painful erections, impotence.
Open trauma of the penis
Surface wounds of the penis includedamage resulting from excessive friction, tearing and tearing of the short frenulum of the foreskin. Such injuries can be accompanied by external bleeding of varying intensity, scarring. The cause of the formation of scalp wounds of the penis becomes the ingress of the penis into various kinds of moving mechanisms. In this case, extensive wound skin defects are formed, often turning to the scrotum, intense pain, bleeding occurs. traumatic shock.
Bitten wounds of the penis are a consequencemanifestations of aggression of domestic animals or deliberate acts of the sexual partner. Despite a small area of damage and minor bleeding, penis bites are usually always infected, so such wounds tend to be prolonged regeneration. Bites inflicted by animals carry the danger of becoming infected with rabies.
Colt-cut wounds of the penis occur inThe result of damage to the piercing-cutting objects (knife, nail, awl, etc.), less often - due to iatrogenic causes (improper operation of circumcision). Injuries of the penis with such a mechanism of application are accompanied by damage to the cavernous bodies, the hanging section of the urethra, and sometimes - full or partial pectectomy. With gunshot wounds of the penis, besides the urethra and cavernous bodies, the scrotum, soft tissues, bones, and pelvic organs are often damaged. The leading symptoms of such injuries of the penis is bleeding, often - the excretion of urine from the wound; presence of foreign bodies in the wound.
The cause of traumatic amputation of the peniscan be violent criminal actions (injuries, bites) or self-mutilation, associated with exacerbation of mental illness. Partial and complete pectectomy is accompanied by massive hemorrhage, shock, and violation of urination.
Thermal trauma of the penis
Factors contributing to frostbite of the sexualbody, serve as general hypothermia, urination in the cold, alcohol intoxication. Frostbite is more often exposed to the foreskin, less often - the body of the penis. As a result of cold trauma, the skin on the affected area acquires a purple-blue hue; there is burning, itching, tingling, paresthesia, swelling of the penis. With an easy degree of frostbite, these phenomena spontaneously disappear within a few days. In more severe cases, necrosis of the tissues, deep purulent ulcers is formed on the affected skin areas, the healing of which is delayed for 3 or more months.
Burns of the penis occur due toeffects on the genital area of hot liquids, chemicals, sunlight, etc. Burn of the 1st degree is accompanied by hyperemia and edema of the penis; II degree - the formation of blisters, subcutaneous edema, a delay in urine; III degree - skin necrosis; IV degree - necrosis of spongy and cavernous bodies.
Diagnosis of penile trauma
Any injury to the penis requires immediatetreatment in a medical institution, where the victim should be examined by a surgeon, traumatologist or urologist. Preliminary diagnosis of the type of injury is based on the history, examination and palpation of the penis. In the future, to determine the severity of injury can be recommended ultrasound of the penis. UZDG, cavernosography. MRI. Since penile trauma often occurs with damage to the urethra, urethroplasty or urethrography may be required to avoid damage to the urethra.
Treatment of injuries of the penis
At the pre-hospital stage, victims with injuriespenis need to provide competent emergency care. As a matter of priority, measures should be taken to temporarily stop the bleeding (apply ice, press an aseptic bandage onto the penis, burn), perform a splint of the penis during its fracture, and start anti-shock measures (adequate anesthesia, infusion therapy). In the hospital, a wound injury is performed (including a burn wound surface of a gunshot wound of an infected wound), removal of foreign bodies. draining of post-traumatic hematomas. revision of the wound and the final stop of bleeding. Patients with bitten wounds must be vaccinated against rabies; with other wounds - antitetanus is administered, according to the indications - anti-gangrenous serum.
Treatment of penile entrapment isremoval of compressive objects. When the penis is dislocated, its open direction is carried out, with sutures applied to the ruptured ligaments and fixation of the cavernous bodies to the pelvic bones. At a fracture of the penis, operative opening of the hematoma is carried out with the removal of blood clots; hemostasis, suturing of the defects of the gall bladder and cavernous bodies, drainage of the wound. Ruptures of the frenulum of the penis require frenuloplasty. Elimination of extensive wound defects is carried out using methods of skin plasty. for which the skin of the scrotum is used (Reich's operation), the pubic region, the abdomen, and free skin flaps. Treatment of thermal injuries of the penis is carried out according to the general principles of treatment of burns and frostbite.
If the urethra is damagedepicystostomy is applied. Restoration of continuity of the urethra is carried out by performing anastomotic urethroplasty or other types of urethral plasty. Neglected penis must be kept, because during the first 24 hours after the injury, it may be microsurgical stitching in the stump. To maintain the viability of the body, it is washed and stored in a sterile container, filled with sodium lactate, on ice. If the reimplantation is not possible, reconstructive phalloplasty is performed.
Prognosis and prevention of penile trauma
Injuries to the penis - serious damage,requiring urgent medical treatment, conducting comprehensive diagnostics and providing qualified assistance. The long-term consequences of unrecognized trauma to the penis may be cavities, abscesses. shortening and deformation of the penis, erectile dysfunction, stricture of the urethra. To prevent damage to the penis will allow protection of the genitals when engaging in traumatic sports, avoiding dangerous positions in sex, raising the level of sexual culture and sex education, careful handling of pets.