Pediatric emergency medicine trisk 3332 3332
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general anesthesia may be required to expose and remove the hair. A high degree
of suspicion should be maintained as complications include urethrocutaneous
fistula or loss of the penis.
Fracture of the penis is produced by traumatic rupture of the corpus
cavernosum. This injury usually occurs when the erect penis is forced against a
hard surface, most commonly during sexual activity. The patient may hear a
cracking sound and develop pain, edema, and deformity of the penis shaft with
abrupt loss of erection. An “eggplant deformity” of the penis is often present. The
urethra may be involved in 3% to 32% of injuries, especially in those with more
extensive or bilateral corporal injuries. Penile fractures require surgical treatment
with evacuation of the penile hematoma, repair of the torn tunica albuginea,
urethral repair if necessary and a pressure dressing.
Superficial lacerations of the penile shaft can be repaired with absorbable
sutures under local anesthesia or penile block. Lacerations extending to the
corporal bodies or the urethra require urologic consultation due to the depth of
injury and significant bleeding. Injuries to the corporal bodies should be repaired
primarily to prevent fibrosis and impotence. If concomitant urethral injury is
suspected, diagnostic evaluation includes a RUG to define the extent of the injury.
Injuries to the urethra may require primary repair and/or temporary urinary
diversion.
Zipper entrapment of the penis or foreskin is a common complaint that can be
managed in the ED. Methods of emergent release have been described in relation
to the zipper parts and depending on the type of zipper. The median bar of the
zipper may be cut with wire cutters and thus disassembling the zipper mechanism
( Fig. 108.6 ). This technique may sometimes prove difficult when the metal bar
is sturdy and there is edema of the entrapped penile tissue within the zipper
fastener, limiting access to the metal bar. Such may be the case with heavy metal
zippers such as those found on jeans and dungarees, and success may depend on
the strength of the operator and the availability of bone or wire cutters. Therefore,
this technique may work best with plastic or lightweight zippers. Cutting the
dentition of the zipper at any position, permitting unzipping of the zipper from the
rear may work best for heavy-duty metal zippers. Disengagement of the fastener
by inserting a flathead screwdriver between the inner and outer faceplates and
applying torque toward the median bar ( Fig. 108.7 ) may prove helpful when it is
difficult to grasp the tiny median bar with bulky cutting pliers. Elliptical incision
of the entrapped foreskin or emergency circumcision can be of value when less
invasive methods have failed. Regardless of technique, procedural sedation may
facilitate the procedure. Edema can be treated with warm soaks.
