Chapter 42 · Urological trauma
External genital trauma
General principles
External genital trauma may be blunt, penetrating, or involve traumatic amputation.
Clinical assessment
- Pain, swelling, hematoma.
- Bleeding.
- Inability to void with urethral injury.
Diagnosis
- Examination.
- Ultrasonography to assess the testis and hematoma.
- Urethrography for suspected urethral injury.
Emergency management
- Hemorrhage control (pressure dressing, surgical hemostasis).
- In testicular rupture, repair the tunica albuginea.
- In penile amputation: first aid (cooling, keeping the tissue moist), replantation.
- In scrotal hematoma: conservative treatment or evacuation.
- In necrosis (Fournier gangrene, paraphimosis): debridement, antibiotics, reconstruction.
Algorithm
| Step | Action |
|---|---|
| 1 | Assess severity and bleeding |
| 2 | Hemorrhage control |
| 3 | Ultrasonography/examination |
| 4 | Rupture → repair |
| 5 | Amputation → cooling, moist protection, replantation |
| 6 | Necrosis → debridement + antibiotics |
Cross-references: Chapters 15, 39–42, and 62.