Urological Emergencies in Clinical Practice стр.90

The defect in the tunica may be closed with absorbable sutures or by nonabsorbable sutures, burying the knots so that

Urological Emergencies in Clinical Practice

FIGURE 5.29. The fracture site in the corpora cavernosum has been identified by a degloving incision. (See this figure in full color in the insert.)

5. TRAUMATIC UROLOGICAL EMERGENCIES 121

the patient is unable to palpate them. Nonabsorbable sutures may possibly be associated with prolonged postoperative pain (Asgari et al. 1996). A urethral catheter is left in place at the end of the procedure since it can be difficult for the patient to void in the immediate postoperative period.

In cases where the urethra has ruptured, this should be repaired at the same time as the tear in the tunica albuginea (Marsh et al. 1999). A spatulated one- or two-layer urethral anastomosis is carried out. The repair is splinted with a urethral catheter, which is left in place for 3 weeks.

There has been a trend away from conservative management of penile fracture toward surgical repair. There are no reported studies where patients have been randomised to conversative versus surgical treatment (and indeed this would be difficult for a condition that presents very infrequently). However, it is generally felt that conservative treatment is associated with a higher rate of complications than is surgical treatment including penile deformity, residual penile mass (presumably scar tissue), prolonged penile pain, and pulsatile cavernosal diverticulum.

Other Penile Injuries

These include bites (from humans or animals), 'zipper' injuries (catching the end of the penis in the zipper of the patient's trousers), injuries as a consequence of inserting the penis into vacuum cleaners, and injuries occurring as a consequence of industrial accidents (e.g., saw or crush injuries).

In general, devitalised tissue should be debrided, but remember that the penis has superb vascularity and aggressive debride-ment is not necessary. The wound should be carefully cleaned, particularly if there is a bite injury and antibiotics should be prescribed with a broad spectrum (a combination of a cephalosporin and amoxycillin is a reasonable empirical choice, but seek advice from your local microbiology department).


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