Management of Penile Defects: A Review

Abstract

Penile amputation is a rare injury. Although, in principle, penile replantation can be performed using a variety of methods, few, if any, standardized procedures exist to deal with this medical emergency. The value of the various microsurgical techniques for replantation of the penis remains uncertain. This article provides a review of the management of penile defects and complications.

Microvascular Penile Replantation Utilizing the Deep Inferior Epigastric Vessels

“…2 Penis can be viable up to 16 hours of cold ischemia 1 or 6 hours of warm ischemia. 4 We advocate a two-team approach to minimize operative time. In our patient, urology performed the suprapubic cystostomy and macroscopic replantation, and the plastic surgery team performed the microvascular portion.…”

“…Traumatic penile amputation is an uncommon occurrence described in psychiatric patients with acute psychosis, but can also be a consequence of accidents, circumcision, assault or domestic violence. [1][2][3][4] It is likely that most plastic surgeons will not treat this problem during their careers. 5 The majority of amputations are secondary to self-mutilation with 87% of cases related to psychosis.…”

Clinical recommendations on penile reconstructive and prosthetic surgery: a consensus statement from the Asia-Pacific Society of Sexual Medicine

“…Penetrating penile (or external genitalia) trauma should be assessed adequately to exclude significant deeper tissue injury since tissue recovery is largely dependent on the depth and surrounding tissue damage from shear forces 10 , 12 , 75 . The primary treatment strategy involves aggressive surgical debridement, removal of foreign material, and preservation of viable tissue, which at times may necessitate multiple procedures 10 , 12 .…”

“…Cosmetic (such as poor graft take or uneven skin color) or functional (such as penile deformity, sensory change, or sexual dysfunction) outcomes may vary depending on the extent of tissue repair in glans reconstruction following penile glans or distal penile shaft injury 10 , 12 . Penile preservation should be always attempted, leaving total corpora cavernosa (neophallus) reconstruction as a last resort only 10 , 12 , 75 . Patients who have suffered partial amputation of the penis or those with residual but reasonable penile stump length (not less than 3 cm so that the patient can still void standing up) can be offered other adjunctive surgical options such as the division of the suspensory ligament or removal of the suprapubic fat pad to maximize the length of the residual penile stump 10 , 12 .…”

“…Patients who have suffered partial amputation of the penis or those with residual but reasonable penile stump length (not less than 3 cm so that the patient can still void standing up) can be offered other adjunctive surgical options such as the division of the suspensory ligament or removal of the suprapubic fat pad to maximize the length of the residual penile stump 10 , 12 . The aims of the surgery are to preserve native penile tissue and enable the patient to void standing up and have a reasonable erect penile length for sexual penetration 10 , 12 , 75 . Total phallic reconstruction (phalloplasty) with penile prosthesis implantation should be offered if all conservative measures fail, the patient is not capable of penetrative sexual intercourse, or in the presence of severe psychological distress 10 , 12 , 75 .…”