Penile crush injuries in male infants caused by falling toilet seats have become more frequent. We suggest ways to minimize this risk. Penile injuries tend to be rare in routine urological practice and are usually associated with pelvic and urethral injuries. Another spectrum are those injuries due to aggressive sexual activity. We report a series of toddlers attending with penile crush injuries.
Four boys (aged 2–4 years) attended as urological emergencies. They were recently toilet-trained and were attempting to void independently. They had lifted the toilet seats, which had then fallen back down, crushing their penises. Three had only preputial oedema with no difficulty in micturition, or urethral bleeding. One had glanular tenderness. There were no signs to suggest urethral injury. Symptoms settled with simple analgesia and all were discharged the following day.
There has been an increase worldwide in the number of wooden and ceramic toilet seats sold . Therefore, an increase in penile crush injury incidence is a possibility.
We suggest a few preventive measures: (i) ‘Soft fall’ toilet seats tend to fall slowly with reduced momentum onto the toilet, markedly reducing risk and degree of injury. (ii) Heavier toilet seats could be banned in households with male infants. (iii) Studies have shown that the social norm of leaving the toilet seat down is inefficient and not always welfare-enhancing . Therefore households with a male infant should agree the default position for the toilet seat should be ‘up’. (iv) Parents could educate their toddlers to hold the toilet seats up with one hand during micturition. Adequate supervision of the children until they are physically able to do this is necessary.