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Evaluation and Management Of Gunshot Wounds Of the Penis
David A Kunkle*, Brett D Lebed*, Steve Lebovitch*, Jack H Mydlo, Michel A Pontari
Temple University Hospital, Philadelphia, PA

Introduction: Gunshot wounds (GSW) to the penis occur infrequently and, when encountered, may cause dilemmas of evaluation and management. We review our experience with GSW to the penis at a high-volume urban trauma center.
Methods: Records of 49 patients treated for GSW to the penis were retrospectively reviewed. Data was analyzed for physical examination findings, diagnostic evaluation, associated injuries, management, and outcome. We detail our technique of penile exploration and artificial erection in the management of these injuries.
Results: Penile wounds and associated injuries are described in Table 1. Thirty-seven (75.5%) patients were taken to the operating room and 32(65.3%) penile explorations were performed. Evaluation included retrograde urethrogram (RUG) in 37/49(75.5%) cases, and urethral injury was diagnosed by RUG in 7/8(75%) of cases. Primary urethral repair was performed in 5/8(62.5%) patients with urethral injury versus 3/8(37.5%) with urinary diversion by suprapubic cystotomy.
Conclusions: Evaluation and management of GSW to the penis may potentially be complex. RUG should be performed in all cases except the most superficial wounds. We describe our technique of penile exploration and artificial erection, noting excellent results in patients in whom follow-up is available. Additional studies are needed to prospectively evaluate management techniques for gunshot urethral injuries.

Table 1. Injuries associated with gunshot wounds of the penis.

	No. Penile GSW	49
	Mean Age + SD (years)	27.6 + 7.7
Penile injuries:	No. with corporotomy only	23 (46.9%)
	No. with urethral injury only	3 (6.1%)
	No. with corporotomy and urethral injury	5 (10.2%)
	No. with superficial penile wounds	18 (36.7%)
Associated injuries:	No. with isolated penile injury	8 (16.3%)
	No. with scrotal/testicular injury	24 (49.0%)
	No. with thigh/femur injury	37 (75.5%)
	No. with intraabdominal injury	5 (10.2%)

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