Treatment for Penile Injury from Fake Pocket Vagina
Penile injuries from fake pocket vaginas should be evaluated and treated according to the type and severity of injury, with prompt surgical exploration and repair indicated for suspected penile fracture or significant tissue damage.
Initial Assessment
When evaluating penile injuries from a pocket vagina device, clinicians should look for:
- Penile swelling and ecchymosis
- History of cracking or snapping sound during use
- Immediate detumescence (loss of erection)
- Penile pain and/or angulation
- Blood at the urethral meatus, gross hematuria, or inability to void
These signs and symptoms are consistent with penile fracture, which is a rupture of the tunica albuginea of the penis 1.
Diagnostic Approach
For Clear Signs of Penile Fracture:
- History and physical examination alone are often diagnostic when classic symptoms are present 1
- Proceed directly to surgical exploration and repair
For Equivocal Signs:
- Ultrasound is recommended as the first-line imaging modality due to wide availability, low cost, and rapid examination times 1
- MRI may be considered when ultrasound results are equivocal
- If imaging remains inconclusive, surgical exploration is still recommended 1
For Suspected Urethral Injury:
- Evaluate for concomitant urethral injury if there is blood at the urethral meatus, gross hematuria, or inability to void 1
- Options for evaluation include urethroscopy and retrograde urethrogram 1
Treatment Algorithm
1. For Penile Fracture:
- Prompt surgical exploration and repair is the standard of care 1
- The repair involves exposing the injured corpus cavernosum through either a ventral midline or circumcision incision
- Tunical repair should be performed with absorbable suture at the time of presentation to improve long-term outcomes 1
2. For Skin/Soft Tissue Injuries:
- For extensive genital skin loss or injury:
- Perform exploration and limited debridement of non-viable tissue 1
- Genital skin is well-vascularized, so tissues with marginal viability may survive due to collateral blood flow
- Wound management options include gauze dressings with frequent changes, silver sulfadiazine or topical antibiotic with occlusive dressing, or negative pressure dressings 1
3. For Urethral Injuries:
- If urethral injury is confirmed:
Important Considerations and Pitfalls
Delay in treatment can lead to complications: Early surgical intervention for penile fracture results in better outcomes with lower risk of erectile dysfunction and penile curvature 1
Don't miss associated urethral injuries: Penile fractures may be associated with urethral injury in 10-22% of cases 1. Missing these can lead to stricture formation, infection, and long-term complications.
Avoid conservative management of penile fracture: Non-surgical management of penile fracture is associated with higher rates of complications including erectile dysfunction, penile curvature, and painful erections 1.
Don't underestimate seemingly minor injuries: Even in the absence of obvious fracture, significant vascular injuries can occur, such as pseudoaneurysm formation 3.
Follow-up is essential: Patients should be monitored for development of complications such as erectile dysfunction, penile curvature, or urethral stricture.