We report the case of a patient with massive penile and scrotal swelling due to use of a compression ring with auto-erotic intent and under the influence of addictive substances. Based on the patient history, the mechanical pressure on the scrotum was about 30 hours (h). The Doppler sonogram showed no central perfusion in either testicle. Conservative treatment with antibiotics and analgesics was initiated with a slight increase in inflammatory parameters and local edema and necrosis formation. Follow-up showed regression of swelling, healing of necrosis and improvement of laboratory parameters. Testosterone substitution therapy was necessary due to the bilateral testicular atrophy that developed.
UNASSIGNED: Es handelt sich um einen Fallbericht einer massiven Penis- und Skrotalschwellung durch Anlegen eines Dichtungsringes in autoerotischer Absicht unter erheblichem Suchtmittelkonsum. Der mechanische Druck auf das Skrotum lag anamnestisch bei ca. 30 Stunden (h). Beide Hoden waren dopplersonographisch ohne zentrale Perfusion. Eine konservative Therapie mit Antibiose und Analgetika wurde bei dezenter Erhöhung der Entzündungsparameter und lokaler Ödembildung und Nekrosebildung eingeleitet. Im Verlauf zeigten sich eine rückläufige Schwellung, Abheilung der Nekrosen und Besserung der Laborparameter. Die Ausbildung einer Hodenatrophie beidseits erforderte die Notwendigkeit der Testosteronsubstitutionstherapie.

Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).

OBJECTIVE: To determine the utility of a 3D vulvar model for teaching pediatric straddle injury repair.
METHODS: Prospective study.
METHODS: Two academic hospitals.
METHODS: Twenty obstetrics and gynecology residents INTERVENTIONS AND MAIN OUTCOME MEASURES: Knowledge score on the basis of a 7-question pre/post test. Likert scale questions evaluated the 3D model as a teaching tool.
RESULTS: Twenty residents participated; 2 (10%) had ever repaired a straddle injury. Knowledge scores increased after model use and didactic session from 3.05 of possible 7 to 6.35; P = .001. Only 2/20 (10%) residents \"agreed\" or \"strongly agreed\" with the statement, \"I am comfortable repairing a straddle injury\" before the intervention, compared with 19/20 (95%) afterward (P < .001). Of 20 residents, 19 (95%) believed that it simulated surgical experience \"very well\" or \"well.\"
CONCLUSIONS: The use of a 3D pediatric vulvar model can simulate surgical experience and can be an effective teaching tool when combined with a didactic session on pediatric straddle injury.

BACKGROUND: Genitourinary tract trauma caused by ox horn injury in the presence of pelvic organ prolapse (POP) is an extremely rare phenomenon and associated with devastating morbidity.
METHODS: A 50-year-old multiparous postmenopausal woman from rural northwest Ethiopia presented with the primary complaint of urinary incontinence 6 days after she suffered ox horn injury to her prolapsed genitalia. She had stage 3 pelvic organ prolapse with the leading point being the cervix. The anterior vaginal and posterior bladder walls were disrupted with visible draining of the left ureter. The wound was dirty and edematous with whitish discharge. She was admitted to the urogynecology ward and provided with wound care until the infection subsided. Apical prolapse suspension was performed using right sacrospinous fixation, and bladder repair was carried out 6 weeks following the prolapse suspension. She recovered well and was continent when discharged.
CONCLUSIONS: Ox horn injury involving the female lower urogenital tract in the presence of POP is extremely rare. Late presentation after sustaining injury is associated with increased risk of morbidity and long hospital stay, and treatment requires multistage surgery.

Pediatric patients pose a unique host of challenges to the emergency provider across all complaints and ages, but this is particularly notable in the genitourinary (GU) system. The pediatric GU system is different from that of the adult in its etiology of symptoms, complications, and treatments. Based on age, there are variations in the anatomy. These differences result in symptoms and diagnoses that must be managed differently. Although in many respects management is similar to GU emergency conditions in adults, there are, occasionally subtle, differences between the care of children and adults, which can greatly impact outcomes.

Variations in estrogen levels across a woman\'s lifetime lead to important changes in genital physiology and pathophysiology. Low estrogen states like menopause and the prepubertal period share important physiologic changes, including more friable, dry, and inelastic mucosa that is prone to irritation, injury, and infection. These and other factors lead to unique gynecologic pathologic conditions encountered at the extremes of age. Age-specific pathologic conditions and differences in examination techniques are discussed.

Military personnel can experience psychosexual difficulties for a variety of reasons. Problems can arise because of psychological trauma, physical injury, consequences arising from pharmacological and surgical complications and social or emotional concerns relating to intrapersonal and interpersonal relationship dynamics. Such individuals might seek to minimise or avoid resolving their pertinent difficulties, while others can experience cultural, personal or organisational barriers to accessing professional help. This paper offers an overview of the development of a national specialist psychosexual therapy service (PST), commenting specifically on the service delivery for male military personnel. It will also consider factors which may support progress in treatment and reflect upon the importance of considering psychosexual functioning in relationships as part of the broader service-life context, which is especially relevant to military personnel.

Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on-site expertise in genitourethral surgery. A series of consensus statements have been developed by an expert consensus committee comprising members of the British Association of Urological Surgeons (BAUS) Section of Andrology and Genitourethral Surgery together with experts from urology units throughout the UK. Penile amputation is a rare genital emergency, which requires prompt intervention and microsurgical reconstruction. The consensus statements will outline the management of these cases for non-specialist units, as well as recommendations for reconstruction for specialists.

To perform a review of the literature to assess the options for preserving fertility in patients with fertility threatening testicular injuries and their effectiveness to help guide surgeons who encounter these patients in the future.
Medline, Embase and Cochrane library databases were searched using the keywords \'treatment\', \'therapy\', \'management\', \'scrotal trauma/injury\', \'testicular trauma/injury/amputation\', \'fertility\', and \'fertility preservation\'. The inclusion criteria were studies reporting fertility preserving techniques with a history of testicular trauma with loss of one, both, or nearly all testicular parenchymal tissue.
Two cases of testicular sperm extraction (TESE), eight cases of testicular replantation, and one case of cryopreservation after injury were identified. Presence of viable sperm after surgery was found in five of 11 patients. Common reasons for failure of replantation were prolonged ischaemic time and extensive crush injury to the vascular supply of the testis. Both cases of TESE and the single cryopreservation case obtained viable sperm.
Scrotal trauma with threat to fertility is rare. It is important that urologists should consider fertility in any situation where complete or a large amount of testicular tissue loss is at risk of occurring and offer fertility preservation options as locally available.

BACKGROUND: In addition to epididymitis and testicular torsion, emergencies of the external genital are rare. Rapid diagnosis and therapy are essential so that immediate therapy can be provided, which is important for survival (Fournier gangrene) of the patient or for the preservation of erectile function (priapism and penile fracture). A detailed patient history and clinical examination are generally sufficient for correct diagnosis.
RESULTS: Under certain circumstances, it might be useful to perform ultrasound, computed tomography scan or magnetic resonance imaging or retrograde urethrography. A urine analysis is obligatory. In case of penetrating injuries and genital trauma in females, additional imaging should be performed because these are often associated with concomitant injuries of the rectum, vagina, or bladder. Special cases are gunshot wounds, in which caliber and type of weapon play an important role for the degree of damage, and animal or human bites. For animal bites, the risk for rabies infection and in case of a human bite the risk for transmission of HIV and hepatitis should be taken into consideration and post-exposure prophylaxis should possibly be offered.