Adli Ghazian, Rahman Ilham Akbar, Djatisoesanto Wahjoe
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Int J Surg Case Rep. 2023 May;106:108196. doi: 10.1016/j.ijscr.2023.108196. Epub 2023 Apr 15.
Genital self-mutilation (GSM) is a rare phenomenon with a spectrum ranging from a superficial laceration to complete amputation of the external genitalia. These could result in severe impairment of genitourinary functions. Psychotic disorder adds to the complexity of the patients. Since GSM is underreported, we report the first case series in Indonesia.
Four included patients comprised different injuries to the external genitalia, from a superficial laceration to penile amputation. Notably, these patients exhibited psychotic traits. Initial management consisted of bleeding control, debridement, and primary suturing. Depending on the extent of the injury, the repair comprised of spermatic cord ligation, penile reconstruction using a skin flap, defect closure with urethral spatulation, and exploration. We successfully managed all the patients surgically before undergoing psychotherapy to improve the patient's overall well-being and to reduce the risk of similar reoccurrence of GSM behavior.
The majority of GSM cases were associated with psychotic disorders. The current reports' injuries include penile laceration, total penile amputation, unilateral castration, and combined injury to the penis and scrotum. Although most GSM is not life-threatening, it may cause emergent, complex, and serious complications such as massive hemorrhage and severe infections. Appropriate investigations with systematic treatment strategies are required, especially in complex cases.
The incidence of genital self-mutilation necessitates a prompt evaluation of organ viability and the possibility of preserving tissue for optimal urinary and sexual outcomes. Interdisciplinary collaboration is required as the primary concern for management in cases of genital self-mutilation involving male genitalia and underlying psychological disorders.
生殖器自残(GSM)是一种罕见现象,其范围从浅表撕裂伤至外生殖器完全切除。这些情况可能导致泌尿生殖功能严重受损。精神障碍使患者情况更为复杂。由于GSM报告不足,我们报告印度尼西亚的首例病例系列。
纳入的4例患者外生殖器损伤情况各异,从浅表撕裂伤到阴茎切除。值得注意的是,这些患者表现出精神病性特征。初始处理包括控制出血、清创和一期缝合。根据损伤程度,修复包括精索结扎、使用皮瓣进行阴茎重建、尿道扩张后闭合缺损以及探查。我们在对所有患者成功进行手术治疗后,再进行心理治疗以改善患者的整体健康状况并降低GSM行为再次发生的风险。
大多数GSM病例与精神障碍有关。目前报告的损伤包括阴茎撕裂伤、阴茎全切、单侧阉割以及阴茎和阴囊联合损伤。尽管大多数GSM不会危及生命,但可能会引发紧急、复杂且严重的并发症,如大量出血和严重感染。需要进行适当的检查并制定系统的治疗策略,尤其是在复杂病例中。
生殖器自残的发生率需要对器官活力进行迅速评估,并考虑保留组织以实现最佳泌尿和性功能结果的可能性。对于涉及男性生殖器和潜在心理障碍的生殖器自残病例,跨学科协作是管理的首要关注点。