Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature

Abstract

IntroductionThere is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature.AimTo report on self-inflicted penile amputation and comment on its surgical management and review current literature.MethodsA 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue.Main Outcome MeasuresTo review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes.ResultsWe report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements.ConclusionWe review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53.

Case Report: Non-microscopic surgical management of incomplete penile amputation

“…Jezior et al reported that meticulous anastomosis of cavernosal arteries and dorsal structure was associated with erectile function 16 . A contemporary report recognized the role of microsurgical revascularization in maintaining early and adequate penile blood flow in order to achieve the best appearance and erectile and voiding function outcomes 11 .…”

“…Another successful non-microscopic penile replantation was reported by Mensah et al The aforementioned case reported good voiding flow, cosmetics, and ability of penile erection. They stated name a few, the duration of ischemia time, type and mechanism of injury, severity of injury, as well as microscope use at time of surgery 5,11 .…”

Presentation and resolution of gender dysphoria as a positive symptom in a young schizophrenic man who presented with self‐emasculation: Frontiers of bioethics, psychiatry, and microsurgical genital reconstruction

“…16,17 While most literature focusing on small case series, small meta-analyses have suggested that the best outcomes are achieved with decreased ischemia time and a microsurgical approach. 18 Ischemia time should be <16 hours, replantation should focus on a watertight urethral anastomosis, and the neurovascular anastomosis should preferably be done with a microsurgical approach. 16,18,19 In the presented case, the surgery was completed <12 hours after the injury.…”

“…18 Ischemia time should be <16 hours, replantation should focus on a watertight urethral anastomosis, and the neurovascular anastomosis should preferably be done with a microsurgical approach. 16,18,19 In the presented case, the surgery was completed <12 hours after the injury.…”

Neglected Penile Constricting Injury in a 9 Year Old Child; a Case Report and Challenges of Management

“…Use of multiple options as in the index case may be tried in selected patients. If removal of the strangulating object is not possible by any of the methods because of the size of the object and/or an extreme degree of oedema, the penis may be denuded and postoperatively is treated with the same principles of severe traumatic penile and scrotal avulsion, including skin grafting or using a myo-fascial flap [9,10].…”