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Repair (injury)
What is
Repair (injury)?
Surgical repair of the penis depends on the
severity of the defect. Mild defects may be
repaired in a single procedure, while severe
defects may require two or more procedures.
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Effects
of Repair (injury)
The
goals of surgical therapy are to restore the
penis to its original state prior to injury,
prevent erectile dysfunction, and allow normal
voiding.
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Candidates for Repair (injury)
Ideal
candidates are those with injury or fracture of
the penis.
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Your Consultation
Three
types of incisions are generally employed for
the repair of penile trauma: incision directly
over the defect, circumscribing-degloving
incision, and inguinal-scrotal incision. You may
want to discuss these options with your personal
urologist. Follow-up with your personal
physician is essential.
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The
Repair (injury) Procedure
A
circumferential subcoronal incision provides
exposure after penile fracture and most
penetrating injuries of the shaft and permits
corporal and urethral repair. The superficial
layers and skin are bluntly degloved back to the
base of the penis. For deeper injuries, proximal
to the suspensory ligament or in the crura, a
penoscrotal or perineal incision is required to
provide access to the corpus cavernosum. Rupture
of the corpus cavernosum as a result of a
fracture, a stab wound, or a bullet wound is
signaled by the presence of active bleeding and
a defect in the fibrous tunica albuginea.
Careful exploration and inspection of the corpus
spongiosum are mandatory, even if urethrography
shows no extravasation. Tunical ruptures caused
by fracture are transversely oriented [see
Figure 16 -- omitted] and sometimes extend
behind the spongiosum; this structure may have
to be mobilized and retracted for adequate
visualization of the injury.
The
tunica albuginea is closed with interrupted 3-0
slowly absorbable sutures. Debridement and
curettage have occasionally been used in this
setting but generally are reserved for late
presentations. Skin closure is possible with
most penetrating injuries to the penis. The
extensive vascular supply to the skin is rarely
compromised. Interrupted chromic sutures provide
a cosmetic closure and allow drainage of
residual blood between the sutures.
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Recovery
A
lightly compressive dressing is sufficient;
tight wraps are to be avoided because they may
lead to necrosis of swollen shaft skin. Catheter
drainage is mandatory if urethral injury is
present.
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Risks
Risks
for any anesthesia are reactions to medications
and problems breathing. Risks for any surgery
are bleeding and infection. The most common
complication is swelling of the penis which
usually resolves within a few days.
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Frequently Asked Questions
Q:
What causes fracture to the penis?
A:
Fracture of the penis is an uncommon pathology.
It consists in a rupture of the tunica albuginea
of one or both corporacavernosa following injury
to an erect penis. The most common causes are
blunt trauma during sexual intercourse,
masturbation, unconscious nocturnal penile
manipulation or a fall onto the erect penis
Q:
What happens when a penis fractures?
A:
All patients refer to have heard a
characteristic "cracking sound" during
intercourse followed by immediate loss of
erection, onset of severe pain and swelling of
the penis. The subsequent penile hematoma which
formed, brought about penile deformity and
discoloration, which differed in severity from
patient to patient.
Q:
What happens during the repair procedure?
A:
Principles of surgical therapy are as follows:
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Optimize the surgical exposure
-
Evacuate the hematoma
-
Identify the site of injury
-
Correct the defect in the tunica albuginea
-
Repair the urethral injury
Q:
What are the benefits of surgical repair?
A:
Microsurgical repair techniques have certain
advantages, including better preservation of the
penile shaft skin and the possibility of a
sensate glans and normal orgasmic function.
Q:
What should I do after surgery?
A:
Immediately after surgery, the penis is securely
taped to the abdomen to for stability.
Medications may be given to relieve pain. You
are encouraged to take fluids to maintain urine
output to avoid pressure on the urethra.
Hospitalization is usually 2 to 3 days. Lots of
fluids and frequent urination should continue
after release from the hospital. Strenuous
activity should be avoided until the surgical
repair is fully healed.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
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