Objectives: To perform a retrospective study to evaluate the circumstances, extent of trauma, and modalities of treatment for penile injuries caused by firearms in a large metropolitan area. The management of civilian injuries differs significantly from that of the military, and experience with penetrating trauma to the external male genitalia in civilian life has been minimally reported. Methods: From 1989 to 2006, 58 patients with gunshot wounds of the penis were evaluated at Jackson Memorial Hospital in Miami, Florida. Results: The mean age at presentation was 29.0 years. Of the 58 patients, 76% were African American. The source of injury was unstated in 50% of cases and was related to criminal causes in 43% and to accidents in 7%. Most patients presented with associated injuries (90%), most commonly of the lower extremities (69%) or the scrotum (52%). Retrograde urethrography was performed in 45 patients, of whom 24% demonstrated contrast extravasation. Of the 58 patients, 72% underwent surgical exploration, with the remaining treated conservatively. Of the 42 patients who underwent surgery, 19 underwent exploration by penile degloving, 17 underwent local exploration, and 6 with a penoscrotal approach. Conclusions: Gunshot wounds to the penis are rare and are commonly associated with injuries of other organs. In sharp contrast to military injuries, minimal tissue destruction is seen, and minimal debridement is needed. If corporal injuries are suspected, penile exploration is warranted. If, in addition, the suspicion for testicular injury is high, penile and scrotal exploration can be performed using a penoscrotal approach.
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