Using Urethroplasty as an immediate treatment for gunshot-induced penis injury during the Syrian war: Case report.

Introduction And Importance: Wars and armed conflicts often result in gunshot injuries, including penile trauma, in military personnel or civilians. Urinary system damage occurs in 0.5-4.2 % of cases involving harm to all organs and systems during combat conflicts. We report the immediate Urethroplasty for gunshot-induced penile injury.

Case Presentation: A 25-year-old Syrian soldier presented to the emergency department with difficulty urinating due to a gunshot wound to the penis. Physical examination showed bruising on the scrotum and penis. Computed tomography scan confirmed a gunshot injury to the bulbar urethra. Under general anesthesia, a circumcised incision was made and it was observed a significant loss of 14 cm of the penile and bulbar urethra on the ventral side. The bullet was removed. The urethral plate was suspended, sutures were placed on the dorsal side, and a graft was taken from the dermis of the left Iliac skin for ventral urethroplasty. A follow-up retrograde urethrogram showed normal results.

Clinical Discussion: Injuries of genitourinary from trauma, particularly involving the penis, are uncommon. Generally, gunshot wounds to the penis can cause various injuries, ranging from superficial to deep. The trauma team and urologists should stay alert in evaluating the patient for additional injuries outside the genitourinary system, particularly rectum, colon, and/or small bowel injuries, which were present in over 50 % of the major non-genitourinary injuries observed.

Conclusion: Although urinary and reproductive system injuries are uncommon, their management is important for every urologist and emergency physician because they have physical and psychological effects on the patient.