Isolated Penile Injury in Boys: Accident, Negligence, or Abuse?

Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys.

Methods: A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital.

Results: Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet ( = 5), postcircumcision ( = 2), dog bite ( = 1), and scald injury ( = 1). Extent of injury includes complete urethral transection at corona ( = 4); loss of urethral plate in a case of hypospadias ( = 1); complete loss of glans ( = 1); penile transection at corona ( = 1); total penile amputation ( = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin ( = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus ( = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end-end anastomoses ( = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty ( = 1); and Bracka's staged urethroplasty ( = 1). Complications include wound infection following trauma ( = 4), postsurgical infection ( = 3), urethrocutaneous fistula ( = 2), and reapplication of penile hair tourniquet ( = 1).

Conclusion: Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.