Male external genitalia self-mutilation in Burkina Faso: Nationwide study of 13 cases

Abstract

INTRODUCTION: Genital self-mutilation is an infrequent uro-psychiatric emergency in urological practice. Many authors have emphasized its rarity in the literature. In Burkina Faso, the incidence and prevalence are poorly due to under-notification and the absence of large-scale studies. We proposed this multicenter study to determine the epidemiological, diagnostic, therapeutic and evolutionary aspects of male external genitalia (MEG) self-mutilation in Burkina Faso. MATERIALS AND METHODS: A retrospective multicenter study was conducted, including all patients treated for male external genitalia self-mutilation in 03 referral university hospital centers in Burkina Faso from January 1, 2018 to December 31, 2024. Penile and testicular injuries were classified according to the American Association for the Surgery of Trauma (AAST) classification. RESULTS: We collected 13 cases of MEG self-mutilation. The average age was 29.54 years with extremes of 18 and 62 years. All our patients were single and had a low socioeconomic standard of living. All the patients had psychiatric history. Lesion assessment revealed 3 cases of penis strangulation by metal ring, 6 cases of isolated penile section, 3 cases of testicular section + penile section and one case of isolated testicular section. AAST I penile lesions were trimmed with haemostasis and simple skin suture. Urethrostomies and stump regularizations dominated the procedures performed in cases of AAST V penile section. We noted a single penile reimplantation without magnifying glasses in a case of near-complete penile section of the penis AAST IV. Postoperative follow-up was straightforward in 12 cases and complicated by necrosis of the reimplanted segment in 1 case. Sequelae were unsightly and functional in cases of AAST IV and V section. CONCLUSIONS: Self-mutilation lesions in MEG are varied, and their management have benefited from the contribution of microsurgery in developed countries. It remains problematic in developing countries.