paint ball injury resulting in penoscrotal lymphedema

PAINT BALL INJURY RESULTING IN PENOSCROTAL LYMPHEDEMA VINEET AGRAWAL, CHI LI, SUKS MINHAS, AND DAVID RALPH A 33-year-old man presented with penoscrotal swelling after an injury during a paint-ball game. The physical examination revealed a phimo- sis and significant swelling over the penile base and upper scrotum, which was confirmed by penile magnetic resonance imaging (Figs. 1 and 2). Cir- cumcision and excision of the edematous scrotal skin down to the dartos layer was performed as an emergency procedure, and 6 months later, residual lymphedematous tissue was widely excised from the right penoscrotal area. A third procedure to refashion the penile skin was needed to produce satisfactory cosmesis (Fig. 3). COMMENT Paint ball is gaining increasing popularity as an “extreme” sport. A high-pressure carbon dioxide- powered gun fires pellets filled with dye. The pellet is coated with a semisoft gelatin and filled with a “nontoxic” dye mixture. The use of paint ball guns has resulted in a number of reports of injuries, especially to the eye. 1 Injury of bodily parts of in- terest to urologists has been reported only once previously. 2 In performing surgery to the scrotal area, aggressive excision should be avoided because it may jeopardize the integrity of the skin, and because multiple smaller procedures often give a better cosmetic result. REFERENCES 1. Parker JF, and Simon HK: Eye injuries due to paintball sports: a case series. Pediatr Emerg Care 20: 602– 603, 2004. 2. Joudi FN, Lux MM, and Sandlow JI: Testicular rupture secondary to paint ball injury. J Urol 171(2 Pt 1): 797, 2004. From St. Peter’s Andrology Centre and Institute of Urology, Lon- don, United Kingdom Reprint requests: Vineet Agrawal, M.R.C.S.Ed., M.R.C.S.(Eng.), St. Peter’s Andrology Centre and Institute of Urology, London, W1W 7EY, United Kingdom. E-mail: [email protected] Submitted: October 7, 2005, accepted (with revisions): Decem- ber 19, 2005 FIGURE 2. Magnetic resonance image of penis with contrast (transverse section) after 10 mg of Caverject showing severe edema superficially around penis at presentation. FIGURE 1. Magnetic resonance image of penis with contrast (sagittal section) after 10 mg of Caverject showing edema around penile shaft extending down into scrotum at presentation. IMAGES IN CLINICAL UROLOGY © 2006 ELSEVIER INC. UROLOGY 67: 1288 –1289, 2006 • 0090-4295/06/$32.00 1288 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.12.040

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Page 1: Paint ball injury resulting in penoscrotal lymphedema

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IMAGES IN CLINICAL UROLOGY

PAINT BALL INJURY RESULTING INPENOSCROTAL LYMPHEDEMA

VINEET AGRAWAL, CHI LI, SUKS MINHAS, AND DAVID RALPH

Fcspresentation.

Fcsinto scrotum at presentation.

33-year-old man presented with penoscrotalswelling after an injury during a paint-ball

ame. The physical examination revealed a phimo-is and significant swelling over the penile base andpper scrotum, which was confirmed by penileagnetic resonance imaging (Figs. 1 and 2). Cir-

umcision and excision of the edematous scrotalkin down to the dartos layer was performed as anmergency procedure, and 6 months later, residualymphedematous tissue was widely excised fromhe right penoscrotal area. A third procedure toefashion the penile skin was needed to produceatisfactory cosmesis (Fig. 3).

COMMENT

Paint ball is gaining increasing popularity as anextreme” sport. A high-pressure carbon dioxide-owered gun fires pellets filled with dye. The pellets coated with a semisoft gelatin and filled with anontoxic” dye mixture. The use of paint ball gunsas resulted in a number of reports of injuries,specially to the eye.1 Injury of bodily parts of in-erest to urologists has been reported only oncereviously.2 In performing surgery to the scrotalrea, aggressive excision should be avoided be-ause it may jeopardize the integrity of the skin,nd because multiple smaller procedures often givebetter cosmetic result.

REFERENCES

1. Parker JF, and Simon HK: Eye injuries due to paintballports: a case series. Pediatr Emerg Care 20: 602–603, 2004.

2. Joudi FN, Lux MM, and Sandlow JI: Testicular ruptureecondary to paint ball injury. J Urol 171(2 Pt 1): 797, 2004.

rom St. Peter’s Andrology Centre and Institute of Urology, Lon-on, United Kingdom

Reprint requests: Vineet Agrawal, M.R.C.S.Ed., M.R.C.S.(Eng.),t. Peter’s Andrology Centre and Institute of Urology, London,1W 7EY, United Kingdom. E-mail: [email protected]: October 7, 2005, accepted (with revisions): Decem-

er 19, 2005

IGURE 2. Magnetic resonance image of penis withontrast (transverse section) after 10 mg of Caverjecthowing severe edema superficially around penis at

IGURE 1. Magnetic resonance image of penis withontrast (sagittal section) after 10 mg of Caverjecthowing edema around penile shaft extending down

ROLOGY 67: 1288–1289, 2006 • 0090-4295/06/$32.00doi:10.1016/j.urology.2005.12.040