Emergency Surgery

Fracture of the Penis

If the erect penis is subjected to heavy pressure, it bends till it breaks. The bent causes rupture of the convex aspect of the wall of the corpus cavernosum with burst of blood to the outside under the skin leading to a swelling.

This situation usually requires immediate surgical intervention whereby the collected blood is evacuated and the tear is sutured.

If properly repaired, fracture penis will not result in impotence.

Dr.Shaeer; the author of this website has designed a special technique for increasing the accuracy and decreasing the time necessary for repairing fractured penis. The technique is internationally published and applied:

Methylene Blue-Guided Repair of Fractured Penis
O.K.Z. Shaeer
J Sex Med 2006;3:349–354
 

Priapism

Priapism is sustained erection that does not end. It usually results from using medications that induce erection without medical supervision, especially intracorporal injections. It also results from certain diseases such as sickle cell anemia and some tumors.

Since erection occurs by filling up the penis with blood, priapism means that this blood is retained inside the penis for days, which results in clotting of blood inside the penis. The blood clot turns into fibrous tissue (inelastic firm tissue) that prevents erection and causes shortening and deformity of the penis.

Therefore, it is necessary to undo priapism urgently, by aspirating blood out of the penis and injecting certain medications, and if this fails, a shunt operation is performed. It is preferable to treat priapism within 6 hours of its onset if erection is to be preserved.

If treatment is delayed for more than one day, it is usually necessary to insert a penile prosthesis since normal erection will not be restored. The prosthesis should be implanted as soon as possible since the ripening of fibrous tissue makes insertion of the prosthesis very difficult.

Cases where extreme fibrosis has developed and prosthesis insertion faces extreme difficulty can benefit from a unique surgical technique designed by Dr.Shaeer, where an endoscope is inserted inside the penis to remove the fibrous tissue. read more about prosthesis surgery and the technique by Dr.Shaeer here.

 

Torsion of the Testis
 

The testis receives blood vessels from the body, some of which are feeding vessels pouring blood into the testis (arteries), and others are draining vessels carrying blood and waste products away from the testis (veins).

Torsion o the testis is a condition when the testis rotates around its vertical axis, with subsequent rotation and occlusion of the blood vessels, leading to death of the testis within six hours.

Torsion leads to severe sudden pain. It requires immediate consultation of a specialist to determine the necessity of immediate surgical correction. Diagnosis is established by ultrasonography. The latter measures the blood flow in the painful testis in comparison to the normal one. If blood flow is less in the painful one, the condition is diagnosed as torsion. If the flow is higher, then it is a case of inflammation of the testis (epididymo-orchitis). Epididymo-orchitis requires medical treatment, while torsion requires surgical treatment.

Surgical treatment consists of immediate de-torsion (the testis is returned to its normal position) and applying heat and oxygen so that the testis is revived. If it is revived, it is fixed in the correct position so that torsion will not occur again. The other testis is fixed as well because if one testis rotates, the other is liable to rotate too. If the testis cannot be revived, it should be removed. Removal of one testis will not affect fertility or masculinity if the other testis is normal. The earlier treatment is initiated, the more likely it is to save the testis. It is therefore necessary not to ignore testicular pain.

Accidents / Trauma
 
Trauma and accidents affecting the testis may lead to infertility. Examples are direct kicks, blows, and falling astride an object. Trauma may lead to perforation / rupture of the external wall of the testis (tunica albuginea), with expulsion of the sperm producing tissue to the outside and massive bleeding. It is necessary to consult a specialist as urgently, especially if a swelling occurs, to determine the need for surgical repair. The decision is made by ultrasonography.

Surgery consists of evacuation of the collected blood, stopping any source of bleeding and suturing the ruptured testis to seal its wall.