Study of major trauma of genitourinary system in patients referred to emergency center of Babol Shahid Beheshti Hospital [1998-2003]

Trauma is a dynamic process and involves different systems of body according to its severity. Genitourinary system injury is seen in trauma process. This study was done to evaluate the major trauma of genitourinary system with special attention to multiple trauma patients. This descriptive and cross-sectional study was performed on records of 293 patients with genitourinary system trauma who referred to emergency center of Shahid Beheshti hospital from 1998-2004. One hundred and two patients suffering from major trauma of genitourinary system who operated were included in this study. Then necessary information such as sex, age, pattern of trauma, type and mechanism of trauma, involved organ, clinical findings, associated lesions, surgical procedure, laboratory findings, duration of hospitalization and year of admission were obtained and studied. From 102 patients, 92.2% were male and 7.8% were female with mean age of 29.4 +/- 13 years. 33.3% of patients had multiple trauma and 98% of them had blunt trauma. Mean duration of hospitalization was 6.2 +/- 4.4 days. From 13 patients [12.7%] with major kidney trauma, 5 cases had shattered kidney that went under nephrectomy. Only 1 patient [1%] had ureter trauma with final diagnosis of left middle ureter transection. Five patients [4.9%] had intraperitoneal rupture of bladder in which 3 cases had rupture in dome area. Five patients [49%] had urethral injury with clinical findings such as blood at meatus and inability to void. In 50 patients [49%] with penile trauma, 49 patients had penis Fx and 1 case had total amputation of penis and left testis. Fifteen patients [16.7%] had testis trauma in which clinical findings were pain, swelling and ecchymosis. Eleven patients [10.8%] had major trauma of scrotum. According to the results of this study, the most common organ involved in major trauma of genitourinary system was penis. Accurate history and complete physical examination should be considered in patients with multiple trauma

Total amputation of Penis and left testis; case report

Penile amputation is one of the rare complications of genitourinary tract injuries. Most cases of penile amputation are the result of self mutilation in patients suffering from psychiatric diseases. Penile amputation with less common causes is accidental trauma and felonious assault. In this paper we present a case with total amputation of penis and left testis who was treated by a complete team of surgery. A 44 year old man who was injured by combine farm machine and developed total penile amputation from the base and total amputation of left testis from spermatic cord in inguinal area. Patient with hypovolemic shock due to severe bleeding was admitted to emergency ward. After resuscitation of patient and stabilization of vital signs he underwent open cystostomy, perineal urethrostomy and right testis fixation based on severity of trauma, necrosis of amputated segment and nonvisualization of proximal of penis. Now, patient has complete urinary continence and is candidated for penile prosthesis or repair via radius or gracilis muscles but he refuses this procedure. However total amputation of penis and testis in accidental trauma is very rare, a complete surgical team including urologist, microsurgeon and plastic surgeon should be organized and replantation should be performed if distal part of penis is viable