A RARE CASE OF PENIS INJURY

 A  R A R E  C A S E  O F  P E N I S  I N J U R Y

Grigor ANAKIEV, Vojislav NIKOLIĆ, Dragoslav SPASIĆ, Miloš MAKSIMOVIĆ, Zoran STANKOVIĆ

       Patient S. B. from the village of Jelašnica near Niš, a worker by occupation (history of disease No. 192/73). Admitted to the Hospital Department on May 3, 1973, at 9 pm, as an emergency in the state of shock due to bleeding from the genital organs.
       A clinical examination of the injured ascertained that it is the matter of penis amputation, that is, complete cutting off of both cavernous bodies and urethras at the root of the penis. The scrotum was open; the left testis was ejected from the scrotal sac and slightly cut by a sharp blade; it lied bare on the belly skin. The right testis, likewise bare, was located at its place within the scrotum. The penis was hanging on a narrow strip of the scrotum skin. The injury was a cut, of smooth and flat surface, at the level of the abdomen skin. The injured was distinctly pale, his pupils slightly dilated, his consciousness preserved, and greatly irritable. P=100min. The erectile stage of shock was followed by hypovolemia caused by bleeding from the injury. Further on, the state of shock was deepened; arterial tension dropped and the pulse increased. The injured was transferred to the Department for Intensive Care and Reanimation.
       Way of injury: On that very day, the injured came, around 8 pm, to a date with his former girlfriend who felt left and deceived. Yearning for revenge, she came to the date with an already made plan and engaged in a love game. When she felt her partner totally surrendered to love ecstasy she coldbloodedly plunged a knife into his genitals. On hearing a painful scream of the injured his friend, waiting for him close-by, came running to help him. At 9 pm the injured was brought to our Department.
         Two hours after having received the injured, and applied reanimation methods to stabilize his state, we decided on a surgical intervention. We were in two minds about whether to complete amputation of the penis or perform its reimplantation. We opted for the latter. After the chemostasis, we pushed a Tiemann catheter 22 Ch through the urethra of the amputated part of the penis and then pushed it through the remaining part of the urethra to the bladder. Through the catheter we performed urethrorrhaphy. By means of two sutures on the penis septum we drew the amputated part of the penis. The tunica albuginea was also drawn and pinned down by separate sutures circularly while in the second layer we sewed fascia and skin. Finally we did a cystostomy for urine derivation. From the onset we prescribed high doses of antibiotics and enzymes (Fig.1).
         The most immediate postoperative course was uneventful. On the second and even more on the third postoperative day, the penis skin became cold and cyanotic with the emergence of phlyctena and single initial necrotic foci. The state did not essentially alter even on the fourth day but on the fifth postoperative day the penis skin became somewhat warmer while the phlyctena began to get dry. The improvement continued on the sixth day as well; the skin became warm; the colors pale pink, almost normal and the phlyctena got dry. The necrotic foci began to heal. On the ninth day the stitches were removed. The transurethral catheter was removed on the twelfth day while the Pezzer's catheter was removed on the eighteenth postoperative day.
          On June 5, 1973, the patient was discharged from the hospital; he was in a good psychophysical condition. The act of urination was normalized, erection present. At control examinations the patient complained of long painful erections. He had no urination disturbances. Coitus he performed as prolonged; for a while with no orgasm and later on with no disturbances whatsoever.

Conclusion

· The described penis injury represents a heavy damage to the organism, accompanied with physical as well as psychic consequences. The injured cannot urinate in a standing position, only while squatting. Apart from being deprived of sexual enjoyment, the knowledge that he is demasculinized throws him into frequent depressions and finally leads to a feeling of inferiority. Neither should the consequences regarding the preservation of family nor the change of the environment attitudes be left out since all this can induce an antisocial posture and behavior of the injured.
· The revenge by penis amputation is a rare event; but, if it happens, our opinion is that reimplantation should be attempted if the injured gets to the surgical institution in optimal time. If the reimplantation succeeds, all the above listed consequences of the injury are avoided.
· The described case is presented here as rare and instructive both regarding the causes of the injury and the way of inducing it, as well as for the favorable result of the undertaken treatment.

LITERATURE:

Adanja S. (1953) Ratna hirurgija, Medicinska knjiga, Beograd
Rhoacls, R. (1977) Textbook of Surgcry. Lippincott, Philadelphia

AUTHOR: Dr. Grigor Anakiev, urologist, Surgery Department of the Military Hospital Niš, Bul. Braće Taskovića 3, 18000 Niš, Serbia, Yugoslavia

First time published in ACTA MEDICA MEDIANE, Niš 1973