What is the treatment for a penile wound?

Treatment of Penile Wounds

For traumatic penile wounds, immediate surgical exploration with debridement and primary repair is the standard of care, with urethral evaluation mandatory if blood at the meatus, hematuria, or voiding difficulty is present. 1, 2

Initial Assessment and Diagnosis

Clinical Evaluation

• Examine for urethral injury indicators: blood at the urethral meatus, gross hematuria, inability to void, or urinary retention 1, 2
• Assess wound characteristics: depth, location (glans, shaft, prepuce), involvement of corpora cavernosa, and presence of tissue loss 1, 3
• Evaluate for associated injuries: scrotal hematoma, testicular injury, perineal laceration, or pelvic trauma 1, 3

Diagnostic Workup

• Perform urethroscopy or retrograde urethrography if any signs of urethral injury are present—urethroscopy is preferred over retrograde urethrography specifically for penile lesions 1
• Consider ultrasound with Doppler if significant swelling obscures examination or testicular injury is suspected 3
• Intraoperative saline injection can identify additional corporeal body or urethral pathology and assess repair integrity 4

Surgical Management

Immediate Surgical Exploration

• Perform surgical exploration immediately for all penetrating injuries (gunshot, stab wounds) and significant blunt trauma involving the corpora cavernosa 5, 4, 6
• Use a degloving (circumferential) incision as it provides optimal exposure for both blunt and penetrating trauma 4
• Debride all penetrating injuries before repair to remove devitalized tissue and foreign material 4, 6

Wound Repair Technique

• Repair tunical tears with absorbable suture after thorough debridement 2
• Perform primary urethral closure whenever possible if urethral injury is identified—this prevents stricture formation better than delayed repair 6
• Be conservative with tissue debridement in genital wounds, as penile and scrotal skin is highly vascularized with excellent collateral blood flow, allowing marginal tissues to survive 3, 7

Special Considerations

• For extensive skin loss: perform limited debridement of clearly non-viable tissue only, then plan for delayed reconstruction with split-thickness skin grafts or flaps 3, 8, 9
• For superficial wounds only: conservative management may be acceptable in exceptional cases involving only superficial structures without corporal, urethral, or testicular involvement 5

Wound Care and Infection Prevention

Initial Wound Management

• Irrigate thoroughly with large volumes of warm or room temperature water until all foreign matter and debris are removed 3
• Apply topical antibiotic ointment (such as bacitracin) and cover with clean occlusive dressing 3, 10
• Change dressings frequently using gauze, silver sulfadiazine, topical antibiotics, or negative pressure dressings depending on wound extent 3, 7

Antibiotic Prophylaxis

• Administer systemic antibiotics for penetrating injuries—use cefazolin or clindamycin for gram-positive coverage, adding gram-negative coverage for extensive wounds 7
• Limit antibiotic duration to ≤24 hours after injury in the absence of active infection 7

Common Pitfalls to Avoid

• Do not delay surgical exploration in penetrating trauma or suspected corporal involvement—immediate intervention prevents complications including infection, ischemic atrophy, and erectile dysfunction 3, 5, 4
• Do not miss urethral injury—always evaluate when warning signs are present, as urethral involvement occurs in up to 22% of penile trauma cases 2
• Do not over-debride genital tissue—the excellent vascular supply allows marginal tissues to survive, so err on the side of tissue preservation 3, 7
• Do not use silver sulfadiazine on fresh wounds—it impairs healing and should be reserved for specific burn indications 7
• Do not attempt urethral catheterization before imaging if urethral injury is suspected—this can worsen the injury 1

Follow-Up Considerations

• Monitor for complications: wound infection, urethral stricture, erectile dysfunction, penile curvature, and fistula formation 4, 8, 6
• Functional outcomes are generally excellent with immediate surgical management—35 of 40 patients in one series reported adequate erections for intercourse without dysfunction 4
• Complex reconstructions may require staged procedures and specialized techniques tailored to the extent of injury 8