Reconstruction Of The Traumatized Male External Genitalia - SIU 2006, Cape Town, South Africa Instructional Course

February 2, 2007 – 6:12 pm | posted in Men's health, Urology / Nephrology

UroToday.com- The SIU instructional course on Reconstruction of the Traumatized Male Genitalia was chaired by Dick Barnes from South Africa and panel members included Gerald Jordan from Norfolk Virginia, Allen Morey from San Antonio Texas, Michael Metro from Philadelphia, and Andre van der Merwe from Cape Town.

Gerald Jordan started the session with his detailed lecture on Penile Soft Tissue Injury and Amputation. Dr. Jordan discussed traumatic injuries such as avulsions leading to both penile and scrotal soft tissue loss, traumatic injuries and self-mutilations leading to penile loss and chemical and thermal burns. He then outlined management principles and illustrated case discussions with both intraoperative and postoperative photographs. The historical evolution of penile reconstruction with a variety of forearm based flaps was discussed and well as the principles assuring successful replantation of salvageable amputated parts.

Allen Morey lectured on Testicular Injuries. In blunt injuries to the scrotum, swelling and pain can limit the accurate diagnosis of intrascrotal pathology solely based on physical exam. In this setting, scrotal ultrasound has proven invaluable for the accurate diagnosis of testicular rupture. The ultrasonographic finding of heterogeneity of the testicular parenchyma due to a testicular hematoma is the single most important finding documenting testicular rupture. The finding of a rupture of the tunica albuginea is not nearly as specific and only present in 17-20% of injuries. When operated upon in the first 72 hours, testicular salvage rates can be expected to be over 90% and salvage by debridement and orchioplasty should be the ultimate goal.

Michael Metro discussed principles of the management of acute and overtly traumatic injuries that lead to loss of genital skin. Traumatic injuries such as constriction, avulsion, burns and the skin loss that results from infection such as Fournier’s gangrene were discussed. Principles for management including careful debridement, antibiotics and delayed reconstruction with skin grafts and/or flaps were stressed. The use of split-thickness skin grafts for both penile and scrotal reconstruction were illustrated and points such as immobilization, and dressing techniques to accomplish this, were stressed. Flap reconstruction via superomedial thigh flaps was also discussed.

Finally, Andre van der Merwe lectured on Gunshot Trauma to the External Genitalia and specifically discussed a series of 70 patients sustaining this injury at his center. Differences between injuries delivered by low and high velocity missiles were significant with many patients sustaining high velocity injuries expiring prior to treatment of their genital injuries. Low velocity injuries, which dominated his series, were able to be managed in the acute setting in the majority of cases. Principles such as the necessity of endoscopy or radiography to assess the urethra, and the ability to fix these injuries with primary debridement and anastomosis were illustrated.

Dick Barnes from South Africa, Gerald Jordan from Norfolk Virginia, Allen Morey from San Antonio Texas, Michael Metro from Philadelphia, Andre van der Merwe from Cape Town.

Reviewed by UroToday.com Contributing Editor Michael J. Metro, MD

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