Incidence of genitourinary tract injury in all trauma admission vary from 2.2 to 10.3%. Trauma to the external genitalia comprises about 27.8% to 68.1% amongst these urological injuries. Penetrating injuries of the penis in civilians are uncommon, accounting for 6 to 26% of all genital injuries. Genital injuries comprise of injury to the penis, scrotum and the testicles. Penetrating injury due to sharp weapon or GSW may lead to uretheral injury. Investigations of choice are retrograde urography (RGU) for suspected urethral injuriy and (ii) a routine abdominal radiography. RGU positive for contrast extravasation indicates urethral injury and also locates the site of rupture and delineates the urethral anatomy. Management of genital injuries should be as restricted as possible and as conservative as feasible as injury to the sex organ can lead to permanent psychological trauma besides somatic and functional disorders. Most of the gun shot injuries of the penis present with bleeding which can be managed by stitching of the Buck’s fascia. If the deficiency of the Buck’s fascia is large, it can be closed by using the fascia of rectus abdominis muscle. Penile injuries involving the corporal bodies and corpus spongiosum should be considered as wounds of vasculature. Debridement should be limited but thorough. Closure should be done with absorbable sutures after good hemostasis. Replantation of the penis may be tried if the patient presents within 8 hour of partial or complete amputations. A tourniquet should be applied to the proximal penile segment as early as possible to prevent life threatening hemorrhage. The amputated part should be cleaned with sterile normal saline and it should be preserved in normal saline in a container surrounded by ice. If microsurgical surgery cannot be performed for arterial repair, venous re anastomosis should be tried. If venous anastomosis is successful, usually the amputated segment survives. The corpus cavernosa can be approximated easily. The urethra should be repaired over an indwelling catheter.
