Dislocation of the penis: a rare case of genital trauma

Traumatic dislocation of the penis is one of the rarest types of genital trauma. This type of injury is accompanied by a violation of the integrity of the skin and the penile ligamentous apparatus, with the dislocation of the penis into the scrotum under the skin of the thigh, or the area of the pubic joint. The low occurrence frequency of such injuries and the small number of observations described in the literature entails the absence of generally accepted treatment tactics for this category of patients. The article describes a clinical case of successfully treated traumatic dislocation of the penis with penile transposition into the pubic joint area and the formation of subcutaneous urinary leakage after late treatment of the patient for medical care.

Female genital injury—which findings have to be considered physiological using colposcopy with and without toluidine blue dye?

This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.

Tackling gynecological health problems in adolescent girls of rural India: need of the hour

Background: Adolescence is a transient and dynamic period characterised by several changes in the child’s body and mind. Onset of menarche is major physiological milestone in adolescent girls which is often associated with menstrual irregularities and other hormonal events. Aim of the present study was to evaluate the profile of adolescent girls attending the outpatient clinic.Methods: This hospital based cross-sectional, prospective, observational study was conducted at Bafna hospital from January 2019 to December 2020. We analysed 220 consecutive adolescent girls with gynaecological health issues. The data was collected and analysed using pre-designed questionnaire.Results: Menstrual disorders (64.5%) were most common followed by teenage pregnancies (20.9%). Other complaints included vulvar disorders, breast diseases, genital trauma, hirsuitism, UTI and psychological problems. Anemia (28.1%) and PCOS (30.9%) were also diagnosed. Hormonal treatment was offered to 59.5% girls whereas surgical intervention done in 4% for various indications.Conclusions: Menstrual disorders, teenage pregnancies, PCOS and anemia were the most common issues seen. Adolescent gynaecological problems are unique and specific regarding presentation, diagnosis and treatment options. It is important to tackle them on top priority due to its impact on future reproductive health.

Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

<b><i>Objective:</i></b> To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). <b><i>Methods:</i></b> This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. <b><i>Results:</i></b> Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2–13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5–504 h). The mean degree of torsion was 390° (range: 180–720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. <b><i>Conclusions:</i></b> TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents’ awareness regarding TT is also important.

Testicular Doppler ultrasound in scrotal trauma: A diagnostic tool with potentially relevant therapeutic implications

Scrotal trauma is one of the rare causes of genital trauma. Although it is not usually fatal, it generates multiple implications in the social and psychological components, impacting the male reproductive and endocrine functions. Blunt trauma is the most frequent scrotal trauma; however, a non-negligible portion is due to penetrating injuries. Its diagnosis has been clinical and its management has been relegated to exploratory surgical interventions, accompanied by a high testicular loss rate. According to this scenario, timely diagnosis and proper treatment become the management pillars of this entity. Although multiple tools have been described to characterize scrotal lesions objectively, testicular Doppler ultrasound can cost-effectively provide relevant information so as to avoid unnecessary surgical interventions.

Fatal infections in andrology. Atypical clinical presentation of a Fournier’s disease

Background: Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient’s death. Case report: A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene’s foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.