GUNSHOT WOUNDS TO THE MALE EXTERNAL GENITALIA

We report on 23 patients with genital gunshot wounds treated since 1977. Of these 23 patients 16 received 1 shot and 7 received multiple shots. The bullet affected the scrotum in 12 patients, the penis in 4, and the penis and scrotum in the remaining 7. The same missile also compromised the thigh in 15 patients, with major vascular damage in 2. Management was based on serial clinical evaluation and aggressive imaging, related to the missile trajectory. Staging studies were 100% accurate in the patients in whom they were done. Nine patients had damage to the testis (7, 1 bilaterally) and/or spermatic cord (2): 5 required orchiectomy, in 3 the testis was repaired and in 2 the bullet transected the vas, which was ligated with nonabsorbable suture for later repair. Six patients had damage to the corpora, which were repaired. Three patients had urethral rupture (bulbar in 2 and penile in 1): primary repair was feasible in 2 and in 1 (with extensive urethral loss after a shotgun blast) a suprapubic tube was placed for delayed reconstruction. Ten patients had skin penetration only, 5 of whom were managed nonoperatively. There were no major complications or mortality. Also, there were no delayed problems in the nonoperated patients. Erection and normal voiding were reportedly present in all who underwent reconstruction and returned for followup. Early surgical exploration with conservative debridement and primary repair of damaged structures is the preferred treatment for these injuries.