PS 05. Male Genital Trauma and Reconstructive Surgery - The Houston Experience".

Male genital trauma occurs in markedly varying forms and levels of complexity. Most genital injuries benefit from early surgical exploration and repair. Penile fracture from trauma sustained during sexual activity may result in significant laceration to the tunica albuginea and should be addressed surgically upon presentation; 10% of such injuries may be complicated by urethral tearing, which is treated by suture repair or reanastomosis. Blunt injuries to the penis resulting in hematoma may require evacuation and repair, but are uncommon. Blunt scrotal trauma is well-evaluated by physical examination and ultrasound. Large hematoceles should be surgically drained. Blunt testicular rupture should be repaired with conservative debridement of testicular tissue. When testicular tunica albuginea is insufficient for closure, local tissue transfer techniques are applicable. Penetrating injuries to the genital region usually require surgical exploration and repair. Foreign material should be removed, and careful wound exploration performed. One must consider the potential for vascular, rectal and pelvic visceral injury, when evaluating penetrating genital trauma. Microsurgical techniques may be necessary for reconstruction of specific genital injuries, particularly when spermatic cord structures or penile dorsal neurovascular structures are involved. Principles of meticulous dissection, conservative debridement with reexploration when tissues of uncertain viability are evident, and selective use of delayed reconstructive approaches will be discussed with extensive presentation of clinical case examples. The late outcomes of genital injury on sexual and reproductive function are important considerations and will also be discussed.