Injuries of the scrotum and its contents
Traumatic injuries are divided into closed and open. Closed injuries are accompanied by extensive hematomas that can spread to the thighs, perineum, and anterior abdominal wall. Open wounds can be isolated or combined, involving the urethra, urinary bladder, or penis.
Surgical management of open wounds includes primary surgical debridement (PSD) with excision of only necrotic areas and foreign bodies, placement of approximating sutures, and mandatory use of a drain or Penrose drain. When the testes are completely exposed, the skin defect is closed by creating subcutaneous pockets on the inner thigh. Open testicular injuries require hemostasis and maximum organ preservation: viable tissue and even fragmented pieces lacking blood supply are preserved by suturing the tunica albuginea.
Basic penile operations
Standard interventions include:
- Frenulotomy — performed under local anesthesia with novocaine. The taut frenulum is incised transversely and closed with 2–3 silk sutures in a longitudinal direction.
- Circumcision — the primary indication is phimosis. The prepuce is pulled forward, excised, and the inner and outer layers are joined with interrupted sutures.
- Incision for paraphimosis (Paraphimosis) — the constricting ring is incised through all layers, after which the prepuce is repositioned over the glans and anti-inflammatory therapy is administered.
Paraphimosis surgery and amputation
In cases of incarceration of the glans penis, in addition to a simple incision, the specialized Hajeck-Rocher procedure is used. The method involves incisions on the convex side of the constricting ring followed by excision of a flap from its outer layer and placement of interrupted sutures.
In severe cases (malignant tumors or crush injuries), penile amputation is performed. The technique includes sparing circular incision of tissues down to the tunica albuginea, ligation of vessels beneath the fascia, and proximal mobilization of the skin. The corpora cavernosa are transected separately from the urethra. The urethra is separated and transected so that its stump projects 1.5–2.0 cm longer than the main organ, after which it is incised along the lower surface to form a new meatus.
Briefly: answers to topical questions
Which exact anatomical layers of the prepuce are incised during the surgical treatment of paraphimosis?
During the surgical treatment of paraphimosis, the constricting ring of the prepuce is incised through all layers, without specifying their exact anatomical names.
Depending on the technique, the following are performed:
- Simple incision — complete incision of the tissues of the constricting ring.
- Hajeck-Rocher procedure — isolation and excision of a flap consisting of the outer layer of the constricting ring.
MNEMONIC: Urethra longer (by 1.5–2 cm during amputation), Drain in the scrotum, Amputation for tumors, Incision for paraphimosis.
Class and exam questions
What are the main indications for penile amputation?
The main indications are severe traumatic crush injuries and malignant tumors.
How to properly manage scrotal wounds during surgical debridement?
Primary surgical debridement is performed with removal of only necrotic tissues and foreign bodies, approximating sutures are placed, and a drain or Penrose drain must be used.
What is the specific feature of urethral transection during penile amputation?
The urethra is mobilized distally and transected so that its stump projects 1.5–2.0 cm longer than the stump of the corpora cavernosa, and then incised along the lower surface.
What else to study on this topic
- Step-by-step technique of the Hajeck-Rocher procedure for paraphimosis
- Features of creating subcutaneous pockets on the thighs for scrotal skin defects
- Rules for sparing penile amputation and vessel ligation beneath the fascia
- The surgeon's tactics in combined scrotal injuries with urethral and bladder damage
- Anatomical differences between the layers in circumcision
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