Management of mammalian bites to the external genitalia: a scoping review

• Published in: BJU international 2022-12, Vol.130 (6), p.722-729
• Main Authors: Patel, Sagar R., Kanabur, Pratik, Possoit, Harlee E., Kinley, Austin, Varman, Beatriz, Coburn, Michael, Sukumar, Shyam
• Format: Article
• Language: English
• Subjects: Animal bites; bite wounds; Debridement; external genitalia; Genitalia; mammalian bites; Meta-analysis; Penis; Perineum; Reconstructive surgery; Trauma; Urology; UroTrauma
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.15671

Objective To review existing publications to determine the approaches for the medical and operative management of mammalian bites to the external genitalia. Materials and Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis for Scoping Review guidelines were followed. Four databases were searched. Articles were independently screened and analysed by two reviewers. Publications were included if detailed summaries of genitalia bites and management were documented. Discrepancies were resolved by a third reviewer. Data were extracted from the final article cohort. Results A total of 42 articles were included in this scoping review with 67 cases of mammalian bites to the genitalia reported in the cohort. The most common injury site was the penis (44.9%). Dog and human bites were the most common type of mammalian bites (61.2% and 26.9%, respectively). In all, 13.4% of cases were managed with medical therapy while 86.6% of cases required surgical intervention. The most common intervention was wound irrigation, debridement, and primary closure (32.8%). Although uncommon, other operative approaches included skin flaps (7.5%) and grafts (4.5%), re‐implantation (4.5%), urethroplasty/repair (7.5%), penectomy (3.0%), scrotoplasty (3.0%), and perineal urethrostomy (1.5%). The reported complication rate was 19.4%. The mean follow‐up time was 39.9 months. Conclusion Trauma related to mammalian bites is associated with high utilisation of healthcare resources and cost. Although management of such bites to the genitalia is controversial, surgical intervention is often warranted ranging from simple debridement of devitalised tissue to complex reconstructive surgery. This review underscores the need for further investigation of mammalian bites to the genitalia to improve surgical options and monitor for long‐term complication rates.