Tuesday, April 22, 2014

Mule bites off man's penis in Morocco

How unlucky can you get?! Believe it or not - several years ago a 38-year-old married man in Morocco was referred to the Urology Division of the Mohammed the VIth University Hospital in Marrakech for evaluation after an attack by his mule. As funny as this may sound - the situation was not humorous at all, since the bite had resulted in a severe injury to the genital area. I have no idea what the guy did to infuriate the animal, or how he came to be tending his mule while (presumably) unclothed, or wearing only undies (I don't think a mule would be able to chew off a body part through a pair of work trousers). Anyhow - his penis had been completely amputated, along with part of the urethra. All the erectile bodies had been pulled out. Not surprisingly, there had been profuse bleeding right after the injury. A scrotal wound was also noted, but the testes were intact. 

 Complete penile amputation caused by a mule bite. Trauma to the scrotum is also visible.

 Extent of penile amputation - basically not much is left besides the scrotum and testes. Note the catheter in the urethra. (Images from: Lakmichi et al.)

The patient was put on intravenous antibiotics and received passive immunization against rabies and tetanus. His wound was debrided, then copiously irrigated with saline and a disinfectant solution. He was catheterized, and surgical repair was undertaken. Specifically, a phalloplasty was performed from the remaining penile shaft with a scrotal flap; however, in a second step, a final phalloplasty will be performed with a groin flap. A penile prosthesis will then be implanted. 

One of the main problems in bite wounds is the risk of infection; the risk is up to 30% in uncomplicated wounds. However, in this case the amputee had an uneventful recovery with no complications. He was discharged on the seventh postoperative day, when no signs of infection were noted. He was treated with wide-spectrum antibiotics and analgesics for another 7 days, and also received psychological counseling to help him deal with the traumatizing loss.

Whew. If you're planning on spending a vacation in Morocco, watch out for vicious mules.

The cosmetic result 12 weeks after phalloplasty. The wound has healed nicely (if that's any consolation for the patient). Later on, a penile prosthesis will be implanted. (Image from: Lakmichi et al.)

Lakmichi MA, Wakrim B, Jarir R, Dahami Z, Moudouni MS, Sarf I. (2011) Mule Bite to the Male Genitalia with Complete Penile and Anterior Urethra Amputation: Unusual Case and Review of the Literature. SRN Urol. 2011: 723154. Published online Apr 19, 2011. 

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