Penetrating Scrotal Injuries: A War Time Experience in a Civilian Setup

Authors

  • Ammar Fadil Abid Department of Uro-surgery, Medical College, Al-Mustansiriyah University, Al-Yarmouk Teaching Hospital, Baghdad, Iraq https://orcid.org/0000-0001-7310-145X
  • Naimet Naoum Consultant Urologist, Medical College, Al-Mustansiriyah University, Al-Yarmouk Teaching Hospital, Baghdad, Iraq https://orcid.org/0000-0003-2137-9710

DOI:

https://doi.org/10.3889/oamjms.2021.6888

Keywords:

Testicle, External genitalia, Blast injury, Gunshot

Abstract

AIM: To present our experience in managing testicular involvement in penetrating scrotal injuries, trying to highlight a possible role for conservative management of selected cases.

METHODS: We reviewed retrospectively all-penetrating scrotal injuries presented to Alyarmook teaching hospital for the period between January 2009 and November 2015, including only those injured victims who reached the hospital alive. Patients’ charts reviewed regarding their demographic data including age, status being civilian or military, and married or single. We documented as well the cause of injury (bullets vs. explosive devices), laterality, associated injured organs, and type of management performed whether operative or non-operative conservative approach. Postoperative complications were recorded while in-patient and after a follow-up period of at least 1 month.

RESULTS: Thirty-one penetrating scrotal injuries were identified, resulted in 34 injured testicles. The patients’ mean age was 34.35 years (±12.89standard deviation [SD]) (18–70 years). Most of the victims 24 (77.4%) were civilians. Explosive devices were the cause of injury in 23 patients (74.2%), while bullets were the cause in the remaining 8 patients (25.8%). Orchidectomy needed to be done in 17 (50%) testicles, while 11 (32.4%) injured testes were repaired by suturing. Six cases (17.6%) were treated conservatively without any surgical intervention. The overall testicular salvage rate was (50%). Twenty-one patients (68%) had associated injuries, mostly fractures. Complications occurred in 10 (32.2%) patients, including two mortalities.

CONCLUSIONS: Management of genitourinary injuries continues to be a challenging task. In our penetrating testicular injured series, we succeeded to salvage 50% of the injured testes. Non -surgical treatment is feasible in selected patients, an approach that needs further study and longer follow-up.

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References

Waxman S, Beekley A, Morey A, Soderdahl D. Penetrating trauma to the external genitalia in operation Iraqi freedom. Int J Impot Res. 2009;21(2):145-8. https://doi.org/10.1038/ijir.2008.59 PMid:19020522 DOI: https://doi.org/10.1038/ijir.2008.59

Janak JC, Orman JA, Soderdahl DW, Hudak SJ. Epidemiology of genitourinary injuries among male U.S. Service members deployed to Iraq and Afghanistan: Early findings from the trauma outcomes and urogenital health (TOUGH) project. J Urol. 2017;197(2):414-9. Mid:27506692 DOI: https://doi.org/10.1016/j.juro.2016.08.005

Phonsombat S, Master VA, McAninch JW. Penetrating external genital trauma: A 30-year single institution experience. J Urol. 2008;180(1):192. https://doi.org/10.1016/j.juro.2008.03.041 PMid:18499189 DOI: https://doi.org/10.1016/j.juro.2008.03.041

Grigorian A, Livingston JK, Schubl SD, Hasjim BJ, Mayers D, Kuncir E, et al. National analysis of testicular and scrotal trauma in the USA. Res Rep Urol. 2018;10:51-6. https://doi.org/10.2147/rru.s172848 PMid:30128306 DOI: https://doi.org/10.2147/RRU.S172848

Hudak SJ, Morey AF, Rozanski TA, Fox CW Jr. Battlefield urogenital injuries: Changing patterns during the past century. Urology. 2005;65(6):1041-6. https://doi.org/10.1016/j.urology.2004.11.031 PMid:15913731 DOI: https://doi.org/10.1016/j.urology.2004.11.031

Edmond L. Paquette: Genitourinary trauma at a combat support hospital during operation Iraqi freedom: The impact of body armor. J Urol. 2007;177(6):2196-9. https://doi.org/10.1016/j.juro.2007.01.132 PMid:17509316 DOI: https://doi.org/10.1016/j.juro.2007.01.132

Owens BD, Kragh JF Jr., Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008;64(2):295-9. https://doi.org/10.1097/ta.0b013e318163b875 PMid:18301189 DOI: https://doi.org/10.1097/TA.0b013e318163b875

Serkin FB, Soderdahl DW, Hernandez J, Patterson M, Blackbourne L, Wade CE. Combat urologic trauma in US military oversees contingency operations. J Trauma. 2010;69(1):175-8. PMid:20622614 DOI: https://doi.org/10.1097/TA.0b013e3181e45cd1

Williams RJ, Fries CA, Midwinter M, Lambert AW. Battlefield scrotal trauma: How Should it be managed in a deployed military hospital? Injury. 2013;44(9):1246-9. PMid:23587211 DOI: https://doi.org/10.1016/j.injury.2013.02.023

Petros FG, Santucci RA, Al-Saigh NK. The incidence, management, and outcome of penetrating bladder injuries in civilians resultant from armed conflict in Baghdad 2005-2006. Adv Urol. 2009;2009:275634. https://doi.org/10.1155/2009/275634 PMid:19360111 DOI: https://doi.org/10.1155/2009/275634

Al-Azzawi IS, Koraitim MM. Lower genitourinary trauma in modern warfare: The experience from civil violence in Iraq. Injury. 2014;45(5):885-9. https://doi.org/10.1016/j.injury.2014.01.005 PMid:24485550 DOI: https://doi.org/10.1016/j.injury.2014.01.005

Alsaigh NK, Alharoob IS. Renal injuries in penetrating abdominal trauma: Iraqi experience of Alyarmouk teaching hospital. J Urol. 2007;177(4):55. https://doi.org/10.1016/s0022-5347(18)30427-0 DOI: https://doi.org/10.1016/S0022-5347(18)30427-0

Ammar AF, Hussein HL. Ureteral injuries from gunshots and shells of explosive devices. Urol Ann. 2010;2(1):17-20. https://doi.org/10.4103/0974-7796.62920 PMid:20842252 DOI: https://doi.org/10.4103/0974-7796.62920

Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotauma: AUA guideline. J Urol. 2014;192(2):327-35. https://doi.org/10.1016/j.juro.2014.05.004 PMid:24857651 DOI: https://doi.org/10.1016/j.juro.2014.05.004

Balzano FL, Balzano Steven J. Military genitourinary injuries: Past, present, and future. Transl Androl Urol. 2018;7(4):646-52. https://doi.org/10.21037/tau.2018.04.05 PMid:30211054 DOI: https://doi.org/10.21037/tau.2018.04.05

Cannon JW, Hofmann LJ, Glasgow SC, et al. Dismounted complex blast injuries: A comprehensive review of the modern combat experience. J Am Coll Surg. 2016;223(4):652-64.e8. PMid:27481095 DOI: https://doi.org/10.1016/j.jamcollsurg.2016.07.009

Hudac SJ, Hakim S. Operative management of wartime genitourinary injuries at Balad Air Force theater hospital, 2005 to 2008. J Urol. 2009;182(1):180-3. https://doi.org/10.1016/j.juro.2009.02.150 PMid:19450817 DOI: https://doi.org/10.1016/j.juro.2009.02.150

Brandes SB, Buckman RF, Chelsky MJ, Hanno PM. External genitalia gunshot wounds: A ten-year experience with fifty-six cases. J Trauma. 1995;39(2):266. https://doi.org/10.1097/00005373-199508000-00013 PMid:7674395 DOI: https://doi.org/10.1097/00005373-199508000-00013

Kitrey ND, Djakovic N, Hallscheidt P, et al. EAU guidelines on urological trauma. In: European Association of Urology Pocket Guidelines. Arnhem, Netherlands: European Association of Urology EAU; 2020. p. 374-9.

Fackler ML. Civilian gunshot wounds and ballistics: Dispelling the myths. Emerg Med Clin North Am. 1998;16(1):17-28. https://doi.org/10.1016/s0733-8627(05)70346-1 PMid:9496312 DOI: https://doi.org/10.1016/S0733-8627(05)70346-1

Sharma DM, Bowley DM. Immediate surgical management of combat-related injury to the external genitalia. J R Army Med Corps. 2013;159(1):i18. https://doi.org/10.1136/jramc-2013-000023 PMid:23631321 DOI: https://doi.org/10.1136/jramc-2013-000023

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Published

2021-10-14

How to Cite

1.
Abid AF, Naoum N. Penetrating Scrotal Injuries: A War Time Experience in a Civilian Setup. Open Access Maced J Med Sci [Internet]. 2021 Oct. 14 [cited 2024 Mar. 28];9(B):1198-202. Available from: https://oamjms.eu/index.php/mjms/article/view/6888