Occupational
genital injuries during 10 years in pistachio farmers, Rafsanjan, Iran
Abedinzadeh M, MD 1*, Vaseghi H 2, Abedinzadeh
M 3
1- Assistant Prof.,
Dept. of urology,
Moradi hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 2. Medical Student, Tehran University of Medical Sciences,
Tehran, Iran. 3- Student, Javadolaemeh High School, Yazd, Iran
Abstract: Received: September 2011, Accepted:
October 2011
|
Background: Genital
injuries are important because of their association with injuries to major
organs and vasculature of pelvis. Both degolving of genitalia skin and
amputation of penile glans and testis are rare conditions. Although genital
injury is rarely life threatening, it can result in serious sexual,
psychological and physiological consequences. This study aimed to introduce
few very rare cases with genital injuries among pistachio farmers in
Rafsanjan, Iran. Materials
and Methods: This study is a case series conducted from 2000 up to 2009 in
Moradi hospital of Rafsanjan city, Iran. Patients´ data were
gathered during 10 years and analyzed using SPSS software version 16. Results: Among 9
victims of genital injuries, caused by accident with tractor during spraying
pistachio farms, 7 had suffered from partial or total scrotal or penile
degolving, one suffered from testis amputation and one from penile glans
amputation. Mean age of victims was 28.6 ± 3.57 years, and they were
unemployed for 3.1 ± 0.78 weeks on average. Conclusion: In order to
reduce genitalia injuries caused by agricultural machinery, tractors safety
should be given more attention and also pistachio farm workers should become
aware of these occupational risks. |
Key words: Genital, Genitourinary
, Occupational injuries, Trauma, Pistachio farms, Rafsanjan
Introduction
Genital
injuries are important because of their association with injuries to major
organs and vasculature of pelvis [1]. Avulsions or degloving injuries of the
penile and scrotal skin are rare urology emergencies [2]. They mainly occur due
to accidents by industrial machines and agricultural machine belts in which the
clothing of the perineal region is entangled in a rotating machine. Avulsions
may vary from simple lacerations to total emasculations [2, 3]. Generally,
lesions do not damage the cavernous body, the spongy body or the testes; they
only reach the skin, causing minimal bleeding. The overlying skin of the penis
is loose, elastic and highly mobile which predisposes the skin to be ripped
off easily from the penis and cause avulsion injuries [2]. Amputation[*]of
the penile glans is a rare condition. It has been reported from various parts
of the world as isolated cases or small series of patients. The most common
etiology is self-mutilating sharp amputation [4]. Furthermore, penile
amputation and emasculation secondary to injuries caused by modern machinery is
extremely uncommon [2].
Although
genitourinary trauma is rarely life threatening, it can result in serious
psychological and physiological consequences. Also, such lesions are
incapacitating [2, 3] and may be the cause of significant long-term morbidity [5].
Because of unpleasant sexual, psychological and physiological consequences of
genital injuries and to make associated organizations and people aware of these
unpleasant events happening during working in farms, and in order to prevent
more injuries, 9 very rare cases of genital injuries caused by rotating axle
wheel of tractor during 10 years are reported in this study.
Materials
and Methods
This
study is a case series conducted since the years 2000 to 2009 in Moradi
hospital of Rafsanjan city. Moradi hospital has an urology center, and there are
no other urology centers in this city or cities around, so all of urological
patients of the city must ultimately come to this hospital.
As patients
referred to the hospital in the emergency ward, they were examined and
evaluated to see how much damage had occurred. Their blood pressures (BP) and
blood hemoglobin (HB) amounts were measured in order to estimate how much
normal saline or blood they needed. Their genital areas were washed with normal
saline, bandaged with Vaseline gauze, intra venous (IV) ceftriaxone (1gr/12h)
was given to them, and also normal saline IV or blood was administered if
needed when the patient was hemodynamically stabled. Then the patients were
sent to the surgery room. Information about type of the trauma, time of the accident,
duration of their hospitalization and employment status, their BP and blood Hb
as they came to the hospital, age, admission date, normal saline and blood
administration and causes of the accident were recorded on the study checklist
by a trained expert. Then the data were analyzed using SPSS software. For
description of continuous variables, mean and standard deviation (SD) were
reported. The study was conducted in accordance with the principles laid down
in the Declaration of Helsinki, Written informed consent was obtained from all the
patients. Ethical approval was also taken from the ethics committee of
Rafsanjan University of Medical Sciences.
Results
During
the past 10 years, from 2000 to 2009, nine genital injuries had occurred. Accidents
with rotating axel wheel of tractor during spraying pistachio plants in May or
June was the cause of all of these traumas. Three patients needed normal saline
administration and two of them received both normal saline and blood,
considering their BP and HB. Intra venous (IV) ceftriaxone (1gr/12h) was given
to all of the patients in order to prevent infection.
Patients
ranged from 25 to 35 years old, with the mean of 28.6 ± 3.57) years. Mean of their hospitalization days was 5.2 ± 1.56,
(3- 7days) days and they were unemployed for 3.1 ± 0.78, (2- 4weeks)
weeks on average. Two patients were taken to the hospital at night,
whereas, six were taken at noon and one in the morning. Seven patients suffered
from partial or total penile or scrotal degolving, one from amputation of a
testis and degolving scrotal skin of the same side and one from partial penile
cutting including glans. Important factors that were measured for each person
such as type of trauma, their age, date of administration, their BP and HB as
they came to the hospital, normal saline or blood administration,
hospitalization days and unemployment weeks are presented in table 1.
Table1: Some characteristics
of genital injured pistachio farmers during 2000-2009
|
|
Patients characteristics |
|||||||
|
The severity
of resulting injuring |
Age |
date |
BP |
HB |
Normal saline A |
Blood A |
H days |
Unemployment weeks |
|
- total penile skin degolving |
25 |
May 2000 |
N |
N |
No |
No |
5 |
3 |
|
- total penile and scrotal skin
degolving |
33 |
May 2001 |
L : 8.5 |
N |
Yes |
No |
7 |
4 |
|
- amputation of one testis and
degolving scrotal skin of the same side |
28 |
June 2001 |
L : 8 |
L : 8.5 |
Yes |
1 unit |
7 |
4 |
|
26 |
June 2003 |
L : 7.5 |
L : 9.5 |
Yes |
1unit |
7 |
4 |
|
|
35 |
May 2005 |
N |
N |
No |
No |
3 |
2 |
|
|
- total penile and scrotal skin
degolving |
28 |
June 2005 |
L : 8.5 |
N |
Yes |
No |
5 |
3 |
|
- total degolving of penile skin |
31 |
June 2006 |
N |
N |
No |
No |
5 |
3 |
|
- penile and scrotal skin degolving |
27 |
May 2007 |
L : 8 |
N |
Yes |
No |
5 |
3 |
|
- partial degolving of penile skin |
25 |
June 2009 |
N |
N |
No |
No |
3 |
2 |
H:
hospitalization, A: administration, N: normal, L: low.
Discussion
This
study reported 9 cases of scrotum skin degolvitation and penile glans and
testis amputation during 10 years in Rafsanjan city. Accidents by rotating axle
wheel of tractor were the cause of these injuries. In these accidents clothing
is twisted and stripped off, which pulls out the loose elastic skin and other
parts of genitalia. Damages vary from partial degolving to amputation of one
testis. As genital skin is not tightly attached to the areas underneat, most of
these injuries only involve the skin [6]. These injuries have numerous
unpleasant consequences such as urinary or sexual dysfunction and serious
physiological
and
psychological consequences [3, 7].Four articles which were somewhat similar to
our research were found. Luiz & et al reported a case of genital injury due
to industrial machinery accident [8]. Dogra PN. et al
reported a case of penile amputation and emasculation secondary to crushing
injury inflicted by agricultural machinery in their study [9].
Hodonou RK. et al
reported 20 cases of external genitalia trauma with various causes during 10
years [10]. Wang DL, et all
reported 2 cases of a 20 and a 29 year old (two penoscrotal avulsion victims)
that were injured by agricultural machines [3]. We also found genital injuries
due to accidents during working with machines similar to that of the above studies which show the frequency of
this event in the other parts of the world as well. This study reported 9
cases, three different types of genitalia injuries, and was focused on agricultural
machines’ injuries which show the importance of caring about this issue.
The
mean age of victims was 28.6 ± 3.57 years (25 – 35 years) which shows that all of them were in the reproductive age and
such events could cause sexual dysfunction and related psychological consequences. They were on average 3.1 ± 0.78 weeks,
(2-4 weeks) unemployed because of their injuries which probably caused
psychological and economical hardships and disorders. According to recent
studies the psychological burden inflicted on male patients by this type of injuries
is too great and patients may react to genital injuries with defense mechanisms
such as conversation withdrawal, denial, regression, anger, anxiety, and
depression [11,12].
Furthermore,
avoidance of coping with problems of such traumas could be a predictor of post
traumatic stress disorders (PTSD) [13].
Bleeding was severe in testis and
penile glans amputation cases in which the main vessels involved required blood
administration. Degolving complaint bleeding depends on the extent of involved
area, but it wasn’t as severe as amputation cases because only superficial
vessels were involved.
Conclusion
In
this study, all of the patients were working in pistachio farms. They faced
these unpleasant accidents while spraying pistachio plants, which is done 3-4
times in May and June. As spraying is an essential work, tractor safety should
be given more attention or they should be changed in a way to reduce these
unpleasant events. Pistachio farm workers should become aware of these dangers
and wear suitable clothes to avoid initiation of such events. It seems that
proper educational programs are
needed
to be organized for this occupational group. Further investigations are
strongly suggested to work on the preventive methods as well as psychological
and social consequences of this extremely important occupational accident.
Acknowledgment
We
would like to thank Firoozgar Clinical Research Development Center (FCRDC) for
its cooperation , and also Dr Seyed-Mohammad Fereshtehnejad, Dr Mohammad
Aboohoseini Tabari and Dr Kobra Abedinzadeh who helped us with this study.
Conflict
of interest: Non declared
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[*] corresponding to: Mehdi Abedinzadeh, Dept. of urology,
Moradi hospital, Rafsanjan university of medical sciences, Rafsanjan, Iran.
Email: abedinoro@yahoo.com