Unusual Penetrating Injury to the Male Genitalia
A 20-year-old-male presented to the emergency department with a history of penetrating injury to the penis by a needle on the same day. The needle was reported to have accidentally pierced the external genitalia at the penoscrotal junction when the penis was erect. There was no history of hematuria. Upon physical examination, the patient was anxious and his vital signs were normal. The caudal end of the needle was just palpable at the penoscrotal junction on local examination.\nThe results of urinalysis and complete blood examination reports were normal. An X-ray of the pelvis () showed the needle within the pelvis. Ultrasound examination of the abdomen including the genitalia showed a 6-cm needle piercing the prostate from the root of the penis up to the bladder neck. Because the needle was palpable at the penoscrotal junction and the caudal end of the needle was below the urogenital diaphragm (), an urgent surgical exploration with incision over the palpable end of the needle under fluoroscopic guidance was done. This exploration showed the tip of the caudal end of the needle to be inside the corpus cavernosum at the root of the penis (). The needle was manipulated by holding the caudal end at the penoscrotal junction, which showed that the tip of the needle was in and around the bladder neck by piercing the prostate gland. Endoscopic manipulation was not done in this case. The needle was removed intact through exploration of the bulbous cavernosa (). A pressure dressing was applied to the penis and the patients post operative voiding was normal. When the patient was queried about the possibility of self-insertion because accidental injury would be unlikely to push the needle completely through the external genitalia, the patient was too ashamed to admit the cause and was discharged after 2 days. Later, the patient admitted the motive behind the insertion of the needle as sexual gratification. The surgical wound healed well and mild penile edema was noted in the immediate postoperative period. The edema was reduced by a pressure dressing and no complications such as erectile dysfunction or plaque formation occurred during the 1-year follow up after needle removal.