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Summary ofMale Genital
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Self- Mutilations (GSM)
Male genital self-mutilation is an old phenomenon accompanying humanity since the dawn of time.
Having no racial, religious, social, or geographical barriers, this multifactorial malady is mostly governed by either acute or chronic impaired mental statuses of various degrees, where schizophrenia plays an important role with the contribution of many imbricated direct or indirect causes.
Besides schizophrenia, another important subgroup is made of voluntary eunuchs. However, even the motivations of the latter are multiple and sometimes unclear, adding to the complexity of this maze.
Except for a minority of subjects who disclose their intentions or who have already attempted self-inicted injuries, preventive management is not applicable to the great majority of the patients.
Nowadays, apart from the Hijras in India, GSMs are sporadic. Nonetheless, they can be assumed to occur all over the world, although the interest of local researchers varies from one region to another.
In more than one-third of the cases, male GSM involves the removal of the penis alone. Bilateral orchidectomy is second in occurrence followed by combined bilat­eral orchidectomy with penectomy, while unilateral orchidectomy and other minor mutilations or lacerations are found in a small percentage only.
Provided early and effective psychiatric management is initiated peri-operatively and maintained well beyond, modern surgical renement with the introduction of microvascular technique allows better cosmetic and functional results in penile replantation which should always be considered whenever possible. Yet macrovas­cular replantation remains an option when a microvascular technique cannot be performed either due to the absence of equipment or lack of expertise.
Although GSM cannot be fully comprehended and anticipated in the great major­ity of cases, learning the fundamentals of the surgical management of these injuries is of paramount importance for any urologist who wishes to prepare himself/herself for an encounter with a GSM case in his/her daily practice, and early management
56
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 S. A. AL-Mamari, Urogenital Trauma: A Practical Guide,
https://doi.org/10.1007/978-981-99-6171-9_56
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446
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56 Summary ofMale Genital Self-Mutilations (GSM)
and continuous surveillance by the psychiatrist are a sine qua non for the success of the intervention in short and long term.
Index
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A
Abbreviated Injury Scale, 41, 42 Abdomino-perineal or Perineo-transpubic
approach, 259–261 Aberrant renal artery, 12 Acute renal injury (AKI), 43 Albuginea, 230 American Association for the Surgery of
Trauma (AAST) classication, 48,
117, 233 Amputation, 300, 305, 307–309, 322, 328,
337, 349, 399, 409, 411,
422, 437–439 Angioembolization, 55, 58–61, 69, 70,
79, 88, 193 Antegrade nephrostogram, 106, 108, 116,
125, 152 Anterior urethra, 217, 219, 225, 230, 235, 236,
254, 260, 266, 290
bulbar, 226
valves, 220, 221 Apotemnophilia, 427 Arterio-ureteral stula (AUF), 119 Arteriovenous stula, 46, 62, 81, 82, 88 Asopa technique, 272 Aubergine or eggplant deformity, 317 Augmentation enterocystoplasty, 201 Autotransplantation (renal), 151, 152, 154
B
Barbagli technique, 271 Berdaches, 414 Berlin polytrauma denition, 41 Bladder, 13, 95–97, 101, 102, 111, 127–130,
132, 133, 135, 136, 138, 139, 146, 154, 155, 159–166, 169–174, 177–183, 185–190, 193–198,
201–203, 205, 207, 208, 215, 217, 219, 220, 224, 226–230, 234–236, 239–241, 243–245, 247, 251, 252, 261, 267, 281, 285, 286, 289–291, 310, 371, 439
Bladder exstrophy, 165, 201–202, 205, 221,
300, 337 Bladder exstrophy-epispadias complex, 221 Bladder-urethra, 169 Blunt trauma, 17, 21, 27–31, 48, 51–53, 60,
79, 80, 88, 110, 111, 127, 169, 186,
189, 226, 230, 231, 240, 307, 371,
377, 381, 391, 405, 422 Boari ap, 135–136, 140, 141, 145, 146, 148,
149, 152 Bricker technique, 203 Brӧdel’s line, 12 Buccal mucosa graft, 266, 267, 270, 273,
276, 279 Buck's fascia, 298, 299 Bulbar urethra, 217, 220, 225, 227, 230, 243,
245, 256–259, 261, 271, 273 Bullet, 31–34, 51, 186, 330, 395
C
Caenis Syndrome, 421 Calyces (renal), 7 Carzimasium, 413 Castration, 409–418, 422, 428–430, 436, 444 Cavernosography, 320, 321 Chordee, 299, 300, 349, 350 Chujia, 415 Circumcision, 305, 307–309, 327, 329 Colapinto and McCallum
(classication), 233 Collecting tubule of Bellini, 7 Columns of Bertin, 3, 7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 S. A. AL-Mamari, Urogenital Trauma: A Practical Guide,
https://doi.org/10.1007/978-981-99-6171-9
447
448
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Index
Computerized-tomography urography (CTU),
96, 115, 127, 173, 188 Cortex, 6, 7, 10, 12, 44, 59, 165 Cost, 116, 187, 253, 265, 320, 440 Crossed testicular ectopia (CTE), 366, 367 CT-cystoscopy, 189 Cutaneous urostomy, 201, 203 Cybele, 409, 412, 413 Cystography (conventional, CT), 186–190,
208, 228, 236, 245
D
Dartos fascia, 240, 298, 318, 356 de Campos Freire technique, 129 Deceleration injury, 29, 53 Deep dorsal vein rupture, 321 Dermatillomania, 427 Direct vision internal urethrotomy (DVIU),
253, 255, 265–266, 281 DJ stenting (antegrade or retrograde), 124,
127, 128, 193 Dorsal inlay, 269, 270, 272, 279 Dorsal inlay Asopa technique, 272 Dorsal onlay, 270–273, 275 Double zipper hypothesis, 215 Dromedary hump, 7 Drug abuse, 428
E
Ectopic kidney, 13, 27, 85, 138 Ectopic ureter, 101 Embolization, 23, 59–61, 63, 65, 82, 88, 89,
108, 186, 361 Endoscopic realignment, 126, 128, 236, 252,
253, 281–282, 290 Endoureterotomy, 126, 128 Entrance wound, 35, 185 Epididymis, 355, 357–362, 364, 384 Epispadias, 165, 202, 221, 300, 337 Erectile dysfunction, 208, 266, 291, 328, 335,
349, 350, 437, 444 Eshmum complex, 421 Eunuch, 409, 412, 414, 415, 417, 418,
428, 429 European Association of Urology (EAU), 54,
122, 174, 235, 236, 289, 312, 328,
382, 391 Excision-anastomosis, 256 Excision with primary anastomosis, 266, 290 Exit wound, 32, 33 Extraperitoneal bladder rupture, 178, 179 Extravesical technique, 129
F
Fall, 27, 31, 51, 61, 111, 170, 231 Falling astride, 225, 227, 230, 376 Floating prostate, 180, 228, 240
G
Gapometry-urethrometry index, 254 Gender dysphoria, 427 Genital ridge, 355 Genital self-mutilations, 305, 421 Genital tubercle, 215, 216, 218, 295, 299, 355 Gerota’s fascia, 7, 73 Glans penis, 217, 295, 297, 298, 330, 335 Glansectomy, 439 Glasgow Coma Scale, 42, 43, 70
score, 79 Glomeruli, 4, 6, 10 Goldman’s classication, 233, 235 Gubernaculum testis, 355–356 Gunshot wound, 31, 35, 110, 111
H
Haematuria, 185–187, 189, 195, 201, 208 Hallucination, 423 Hematocele, 377, 382, 383, 385 Hematoma, 22–24, 44–46, 53, 56, 59, 60, 70,
71, 87, 88, 118, 186, 190, 194, 196, 208, 218, 227, 228, 239, 240, 243, 245, 265, 270, 317–322, 329, 336, 342, 377, 381, 382, 385–387, 391
Hematuria (haematuria), 45, 51, 52, 58, 83,
115, 185, 186, 239, 381 High-riding prostate, 239, 240 High velocity (bullet), 31, 32, 34, 35 Hijras, 417, 422 Horseshoe kidney, 13 Hutch technique, 129 Hypospadias, 216, 219, 226, 295, 299,
300, 363 Hysterectomy, 106–108, 117, 124, 170,
174, 201
I
Iatrogenic (trauma), 21, 22, 89, 104–110, 121,
125, 127, 128, 138, 151, 170, 172,
174, 185, 189, 196, 223, 225, 226,
230, 231, 290 Ileal conduit urinary diversion, 203 Ileal ureter, 145, 146, 148, 149 Indiana pouch, 204
Index
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449
Injury severity Score (ISS), 31, 42–44, 69, 70,
79, 85, 207 Intraperitoneal bladder rupture, 173, 179, 189 Intra-vesical technique, 129
J
Jerusalem Syndrome, 428
K
Kelly’s sign, 123 Khoja/Chhinni, 417 Kidney, 3–10, 12–14, 21–23, 27–37, 41,
43–46, 48, 54–56, 58–61, 63, 69,
71–76, 79–81, 83, 85–89, 95, 96,
108, 115–119, 128, 134, 140, 146,
151–153, 189, 193, 201, 205, 230,
239, 361, 363, 365, 371, 405 Klingsor Syndrome, 421 Kock pouch, 203, 204 Kulkarni technique, 273
L
Ledbetter-Politano technique, 129 Leech therapy, 438 Leydig cells, 295, 358, 400, 437 Lich-Gregoir technique, 129, 146 Loops of Henle, 7 Low-velocity, 32, 35, 85, 88, 330,
331, 376
M
Macrosurgical (anastomosis), 335, 444 Magnetic resonance imaging
(MRI), 54, 245, 320, 384 Medicinal leeches, 336 Medulla, 6, 10, 44 Membranous urethra, 180, 182, 217,
225, 227–229, 233–235, 245,
246, 256 Mesoderm, 4, 159, 216, 295, 355 Mesonephric duct (Wolfan duct), 355 Mesonephros, 4, 5, 355, 356 Metanephros, 4, 5 Microsurgical, 335, 336, 339, 399, 400,
437–439, 444 Mitrofanoff appendicovesicostomy, 202 Mixt bladder rupture, 358 Motor vehicle accident, 52 Motor vehicle collision, 111 Muscular layer of Waldeyer, 97
N
National Trauma Data Bank (NTDB), 17, 44,
57, 69, 169, 371, 405
Nephrectomy, 7, 12, 30, 35, 44, 48, 55, 58–61,
69–73, 75, 76, 79, 81, 88, 90, 141,
151, 172, 193 Nephron, 11, 22 Nephron-vesical bypass, 154 Nephrostomy, 22 Nipple or valve technique, 129
O
Obturator reex, 172 Onuf’s nucleus, 165 Orchidectomy, 382, 391, 392, 394, 400, 416,
421–423, 427, 429, 433,
436–437, 443 Organ Injury Scale, 46 Orthotopic bladder substitution, 204
P
Pancake kidney, 13, 14 Panurethral stricture, 243 Paramesonephric duct (Müllerian duct), 355 Pear-shaped (bladder), 243, 246 Pelvicalyceal system, 4, 6, 95, 108, 220 Pelvic fracture urethral distraction defects, 225 Pelvic fracture urethral injury, 225 Penectomy, 322, 330, 410, 422–424, 433,
437–439, 443 Penetrating injuries, 17 Penetrating trauma, 21, 31–37, 53, 79, 105,
111, 115, 118, 121, 169, 207, 230,
231, 290, 375, 382, 394 Penile constriction/strangulation, 308, 322 Penile dislocation, 310 Penile fractures, 226, 230, 290, 305, 307, 308,
311–313, 317–322, 327–329,
349, 350 Penile replantation (macrosurgical,
microsurgical), 335–338 Penile transplantation, 343, 344, 436 Penis, 18, 190, 217, 243, 259, 273, 274,
295–300, 305, 307–312, 322, 328,
330, 335–338, 343, 344, 356, 363,
371, 376, 378, 379, 394, 396, 410,
411, 415–417, 427, 429, 433,
435, 437–439 Percutaneous nephrolithotomy, 22–24 Percutaneous nephrostomy, 62, 63, 124,
193, 203 Pericatheter urethrography, 244
450
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Index
Perineal urethrostomy, 267, 322, 328, 439 Periurethral, 244 Permanent cavity, 34 Phallectomy, 410, 416, 433, 443 Pie-in-the-sky bladder, 243, 245 Pneumo-CT-cystography, 189 Posterior urethra, 215, 217, 218, 220, 225,
229–231, 233–236, 240, 251–254, 261–262, 290, 437
Posterior urethral valves, 138, 180, 219–221,
226–230, 233, 234, 240, 252–254, 256, 265, 290
Prepuce, 219, 270, 272, 295–299, 307,
308, 327 Primary endoscopic realignment, 236, 253 Primary megaureter, 101 Primary vesicoureteral reux, 101 Prostate, 138, 163, 164, 170, 182, 216, 217,
219, 223, 228, 229, 231, 233, 235,
239, 240, 257, 260, 286, 299, 355,
362, 443 Prune-Belly Syndrome, 220 Pseudoaneurysm, 46, 62, 65, 81, 85, 88, 152 Pseudotumors, 7 Psoas hitch, 133–134, 140, 141, 145, 148, 149 Psychosis, 427, 428
R
Radial artery free ap phalloplasty, 339 Radial forearm free ap, 339, 340, 343, 439 Railroading techniques, 253 Religious delusions, 416, 423, 427 Renal capsule, 7, 28, 74, 76 Renorrhaphy, 61, 71, 73, 81, 88, 89 Retrograde urography, 116 Revised trauma score, 70, 79, 82, 207 Road trafc accidents, 17, 223, 225, 231, 376
S
Schizophrenia, 428, 439 Scrotal graft, 255, 267 Scrotal or penoscrotal transposition, 363 Scrotoschisis, 366 Scrotoscopy, 384, 387 Scrotum, 178, 190, 295, 298, 308, 311, 344,
355–358, 360–367, 376, 379, 381,
386, 387, 394, 399, 416, 417,
433, 438 Seminiferous tubules, 358, 359, 382, 384, 392,
393, 400 Sentinel clot sign, 189 Sertoli cells, 358
Skoptsy, 416, 417 Sonourethrography, 244 Spermatic cord, 362, 376, 377, 384, 387, 399 Splenogonadal fusion, 364, 365 Spongiobrosis, 230, 245 Spongy urethra, 215–217 Stabbing, 21, 35, 48, 51, 70, 110, 225, 230,
307, 308, 375, 433 Stenosis, 152, 248, 254, 281, 291, 335, 444 Straddle type injury, 226 Strangulation, 308 Stricture, 98, 110, 125, 127, 128, 135, 138,
140, 145–147, 152, 208, 225, 227,
228, 230, 231, 235, 236, 240,
243–245, 251–255, 265–267,
269–271, 273, 274, 281, 285, 286,
291, 330, 336, 342, 437, 444 Supercial dorsal vein rupture, 321 Supernumerary, 12–14 Suprapubic catheter, 193, 196, 241, 252, 257,
260, 261, 290, 322, 437
T
Taguchi technique, 129 Taqaandan, 312 Tear-drop bladder, 243 Temporary cavity, 34 Testicle, 301, 310, 355, 356, 358, 364, 381,
383, 391, 394 Testicular fracture, 377, 382 Testicular reimplantation/replantation/
autotransplantation, 399,
400, 437 Testicular rupture, 375, 377, 381, 382,
384–387, 391 Testicular sperm extraction, 400 Testicular transplantation, 402 Transcatheter angiographic embolization, 65 Transperineal progression approach, 257 Transsexualism, 427–429 Transuretero-ureterostomy, 138–142 Trauma Audit and Research Network, 223 Traumatic dislocation of the
testis (TDT), 377 Trigone, 129, 159, 161, 163, 201 Tube-within-a-tube, 338, 339 Tube Yang-Monti, 202 Tunica, 230 Tunica albuginea, 217, 270–273, 297, 311,
320, 322, 328, 336, 356, 359, 375,
377, 382–384, 386, 387, 392–395,
437, 438 Tunica vaginalis, 356–358, 392–395
Index
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451
U
Ultrasound (Ultrasonography), 22, 220, 320,
336, 365, 382, 384, 385, 387,
392, 438 Undescended testis, 362, 381 Up-and-downogram, 244, 246 Urachus, 133, 159, 161 Ureter, 14, 37, 74, 89, 95–102, 105, 107, 108,
110, 111, 116–118, 123–130,
133–135, 137–140, 145–147, 149,
151, 152, 193, 201, 203, 220, 362 Ureterocalycostomy, 135 Ureterocele, 102 Ureteroneocystostomy, 127–129,
133–134, 151 Uretero-pelvic junction, 101 Ureterosigmoidostomy, 205 Uretero-ureterostomy, 134–135, 146 Urethra, 95, 159–162, 166, 180, 182, 183, 186,
193, 196–198, 201, 204, 208,
215–217, 219–221, 223–231,
233–236, 239–241, 243–245,
247, 248, 251, 253, 255, 257, 260,
261, 265, 269–276, 281, 286, 289,
295, 297–300, 308, 313,
322, 329, 330, 339, 341, 343, 377,
437, 439 Urethral gap, 233, 241, 245, 254, 257, 290 Urethral stricture, 202, 223, 231 Urethra stenosis, 253 Urethrocystography, 243, 320
Urethrography (antegrade, retrograde,
combined), 217, 233, 236, 241, 243, 244, 247, 265, 287, 290, 291, 320
Urethroplasty, 228, 251, 253–255, 258–260,
265–277, 281, 286, 287, 290, 291 Urethro-venous intravasation, 243 Urinary incontinence, 208, 228, 254,
285, 290–291 Urogenital ridge, 355 Urogenital sinus, 159, 160, 215, 216 Urogenital trauma, 17, 30 Urolume endoprosthesis, 281 Uromanual injury/uromanual high voltage
trauma, 309
V
Vaginal ap, 277 Valesians, 412 Van Gogh syndrome, 427 Ventral onlay, 269, 279
W
Weigert-Meyer law, 101
Y
Yakuza, 422 Yang-Monti tube, 203 Yawing bullet, 32
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