1
|
Nhungo CJ, Mkony C, Mtaturu G, Sobbo S, Nzowa B, Mwanga A. "A successful reconstruction of remnants of corporal bodies and penile urethra after Total Glans Penis amputation following surgical circumcision in a 5-year-old boy". A case report and literature review. Int J Surg Case Rep 2024; 115:109267. [PMID: 38232418 PMCID: PMC10828048 DOI: 10.1016/j.ijscr.2024.109267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Circumcision is the most common surgical procedure done in boys. Its complication varies from minor to severe. In most of African countries circumcision is often performed by traditional circumcisers. The management of penile glans amputation depends on the duration before presentation with auto-transplantation being the favorable management in acute phase of presentation. The amputation of the glans is a serious complication of circumcision because it can derange the urinary and sexual functions of a patient and may lead into psychological instability and low self-esteem. CASE PRESENTATION We report a case of total glansectomy in a 5-year old boy who presented 12 months after surgical circumcision which was done by inexperienced medical personnel at his house. Patient presented with a pinhole urethra opening, missing glans, buried phallus with remnants of corporal bodies. Penile exploration was done, with successful significant phallus stump of about 5 cm, phallus reconstruction and meatoplasty was achieved. Partial Skin thickness grafting of the phallus stump was performed. At six- month follow up, the patient had both satisfactory cosmetic and functional outcomes. CLINICAL DISCUSSION Total glansectomy is a rare surgical emergency with auto transplantation being the best option in acute management however successful outcome for a delayed glansectomy depends on proficient surgical penile exploration and comprehensive post operative care. Based on the clinical presentation, the goals of management for our patient were to achieve a largely patent urethral opening in the long term and to prevent further urethral meatal stenosis as well as achieving adequate phallus stump for sexual function. CONCLUSION The amputation of the glans is a serious complication of circumcision because it can derange the urinary and sexual functions of a patient if neglected. Findings on this case report highlight the importance of raising awareness among traditional health care workers to prevent urinary and sexual function disabilities. Prevention of penile amputation can be prevented by providing proper training for circumcisers and providing public education for hospital circumcision.
Collapse
Affiliation(s)
- Charles John Nhungo
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Urology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Charles Mkony
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gabriel Mtaturu
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Urology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Salim Sobbo
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Boniface Nzowa
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ali Mwanga
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
| |
Collapse
|
2
|
Sow O, Ondo CZ, Sarr A, Sine B, Gassama CB, Ndoye AK. Total penile glans amputation following circumcision: A case report of a dramatic complication. Urol Case Rep 2021; 40:101905. [PMID: 34712593 PMCID: PMC8531556 DOI: 10.1016/j.eucr.2021.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/27/2022] Open
Abstract
Circumcision is one of the most commonly performed surgical procedures. As traditional ritual circumcisions are still practiced in the community, in Senegal the majority of circumcisions are performed in hospitals. We report the case of a 9-year-old boy who underwent a total amputation of the glans after a circumcision in a pharmacy by an unqualified agent. A meatoplasty was performed and the postoperative course were uneventful.
Collapse
Affiliation(s)
- Ousmane Sow
- Urology-Andrology Department, Aristide Le Dantec Hospital, Dakar, BP: 3001, Senegal
| | - Cyrille Ze Ondo
- Urology-Andrology Department, Aristide Le Dantec Hospital, Dakar, BP: 3001, Senegal
| | - Alioune Sarr
- Urology-Andrology Department, Aristide Le Dantec Hospital, Dakar, BP: 3001, Senegal
| | - Babacar Sine
- Urology-Andrology Department, Aristide Le Dantec Hospital, Dakar, BP: 3001, Senegal
| | | | - Alain Khassim Ndoye
- Urology-Andrology Department, Aristide Le Dantec Hospital, Dakar, BP: 3001, Senegal
| |
Collapse
|
3
|
Abstract
BACKGROUND Acquired or congenital absence of the penis can lead to severe physical limitations and psychological outcomes. Phallic reconstruction can restore various functional aspects of the penis and reduce psychosocial sequelae. Moreover, some female-to-male transsexuals desire creation of a phallus as part of their gender transition. Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes. METHODS A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through July of 2015 with multiple search terms related to phalloplasty. Data on techniques, outcomes, complications, and patient satisfaction were collected. RESULTS A total of 248 articles were selected and reviewed from the 790 identified. Articles covered a variety of techniques on phalloplasty. Three thousand two hundred thirty-eight patients underwent phalloplasty, with a total of 1753 complications reported, although many articles did not explicitly comment on complications. One hundred four patients underwent penile replantation and two underwent penile transplantation. Satisfaction was high, although most studies did not use validated or quantified approaches to address satisfaction. CONCLUSIONS Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients.
Collapse
|
4
|
Virasoro R, Tonkin JB, McCammon KA, Jordan GH. Penile Amputation: Cosmetic and Functional Results. Sex Med Rev 2015; 3:214-222. [PMID: 27784611 DOI: 10.1002/smrj.50] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Penile amputation is a rare type of external genital trauma. It may arise from accidental trauma, assault or self-inflicted mutilation. As with all trauma, initial management focuses on assessment and resuscitation of the patient. When available, hypothermic preservation of the detached penis should be undertaken. AIM This review serves to compile the current available information on etiology and management of penile amputation injuries, with focus on functional and cosmetic results. MAIN OUTCOME MEASURES Main outcome measures were penile cosmetics, viability, and sensation; urethral patency and graft survival, functionality. METHODS A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1980-2013. RESULTS Due to the rarity of penile amputation injuries, no randomized trials exist. Likewise, available published series on management of this condition are comprised of a small number of patients. CONCLUSIONS Penile amputation is rare but challenging. Current microreplantation procedures have a uniformly good result with a minimum number of post-operative complications. When microreplantation cannot be performed, older corporal reattachment techniques may be offered. When phallic reconstruction is required, a microsurgical free forearm flap phalloplasty may be performed to restore the patient with an acceptable cosmetic and functional phallus. Virasoro R, Tonkin JB, McCammon KA, and Jordan GH. Penile amputation: Cosmetic and functional results. Sex Med Rev 2015;3:214-222.
Collapse
Affiliation(s)
- Ramón Virasoro
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Jeremy B Tonkin
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kurt A McCammon
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Gerald H Jordan
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA
| |
Collapse
|
5
|
Celik A, Ulman I, Ozcan C, Avanoglu A, Erdener A, Gokdemir A. Reconstruction of penile shaft amputation: is microvascular re-anastomosis mandatory? BJU Int 2015; 92 Suppl 3:e41-e42. [PMID: 19127634 DOI: 10.1111/j.1464-410x.2003.04057.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- A Celik
- Department of Paediatric Surgery, Division Of Paediatric Urology, Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | | | | | | |
Collapse
|
6
|
Glanuloplasty with Oral Mucosa Graft following Total Glans Penis Amputation. Case Rep Urol 2014; 2014:671303. [PMID: 25184073 PMCID: PMC4144389 DOI: 10.1155/2014/671303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/21/2014] [Indexed: 12/05/2022] Open
Abstract
This is a report on the technique of neoglans reconstruction in a patient with amputated glans penis following guillotine neonatal circumcision. A 4 cm long and 2 cm wide lower lip oral mucosa graft was harvested and used to graft the distal 2 cm of the corporal bodies after 2 cm of the distal penile skin had been excised. One edge of the lower lip oral mucosa graft was anastomosed to the urethral margins distally and proximally to the skin. At six months of followup, patient had both satisfactory cosmetic and functional outcomes.
Collapse
|
7
|
Svoboda JS, Van Howe RS. Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision. JOURNAL OF MEDICAL ETHICS 2013; 39:434-441. [PMID: 23508208 DOI: 10.1136/medethics-2013-101346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits 'justify access to this procedure for families who choose it,' claiming that whenever and for whatever reason it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given.
Collapse
Affiliation(s)
- J Steven Svoboda
- Attorneys for the Rights of the Child, 2961 Ashby Avenue, Berkeley, CA 94707, USA.
| | | |
Collapse
|
8
|
Abstract
I explain why I think that considerations regarding the opposing rights involved in the practice of circumcision-rights of the individual to bodily integrity and rights of the community to practice its religion-would not help us decide on the desirable policy towards this controversial practice. I then suggest a few measures that are not in conflict with either religious or community rights but that can both reduce the harm that circumcision as currently practiced involves and bring about a change in attitude towards the practice, thus further reducing its frequency. These measures are the compulsory administration of anaesthetics; the banning of the metzitzah b'peh; and having an upper age limit of a few months on non-therapeutic circumcision of minors. I conclude with general considerations on why the steps taken towards the reform of circumcision should be moderate.
Collapse
Affiliation(s)
- Hanoch Ben-Yami
- Department of Philosophy, Central European University, 9 Nádor Street, Budapest 1051, Hungary.
| |
Collapse
|
9
|
A salvage operation for total penis amputation due to circumcision. Arch Plast Surg 2013; 40:247-50. [PMID: 23730602 PMCID: PMC3665870 DOI: 10.5999/aps.2013.40.3.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/08/2013] [Accepted: 03/18/2013] [Indexed: 11/08/2022] Open
Abstract
Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature.
Collapse
|
10
|
Faydaci G, Uğur K, Osman C, Sermin S, Bilal E. Amputation of glans penis: a rare circumcision complication and successful management with primary anastomosis and hyperbaric oxygen therapy. Korean J Urol 2011; 52:147-9. [PMID: 21379434 PMCID: PMC3045722 DOI: 10.4111/kju.2011.52.2.147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 11/22/2010] [Indexed: 11/18/2022] Open
Abstract
Penile amputation is an uncommon condition that requires immediate surgical replantation. Routine standardized procedures for dealing with this medical condition do not exist. We describe a case of complete guillotine-type glans penis amputation and review the relevant literature. We performed urethral end-to-end approximation and glanular anastomosis and then applied hyperbaric oxygen therapy postoperatively. We obtained very good cosmetic and functional results.
Collapse
Affiliation(s)
- Gökhan Faydaci
- Department of Urology Clinic, Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
11
|
Circumcision complications associated with the Plastibell device and conventional dissection surgery: a trial of 586 infants of ages up to 12 months. Adv Urol 2008:606123. [PMID: 19009030 PMCID: PMC2581731 DOI: 10.1155/2008/606123] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 09/02/2008] [Indexed: 11/26/2022] Open
Abstract
Conventional dissection surgery (CDS) or using the Plastibell device (PD) is the method most frequently employed for circumcision. The aim of this study was to evaluate two methods in terms of the incidence of complications in infants of ages up to 12 months. In a prospective study, 586 infants equal to or less than 12 months were studied from 2002 to 2008, and complications between the two groups were assessed. The overall rates of complications in CDS and PD groups were 1.95% and 7.08%, respectively. In each group, the rate of complications was not different among children who had a normal weight, compared to those of a lower or upper (10%) weight. There was a significant positive correlation between the age and weight of subjects within the time of ring separation (P < .001). The results of this study suggest the PD method for neonates and low-weight infants with thin prepuce and the CDS for other infants.
Collapse
|
12
|
Abstract
OBJECTIVE To remove the preputium by using a simple, quick and safe method without damaging glans, frenulum and urethra as well as with a good cosmetic result. PATIENTS AND METHODS The procedure, remind the guillotine technique at first, but completely different from it. Basically, a long haemostat is applied onto preputium and skin and subdermal tissue were incised; a small window is opened at dorsal of preputial mucosa and it is excised, while observing glans and frenulum. RESULTS The circumcisions were performed in a quick, safe and pretty bloodless way. There was no case with glans amputation, frenulum short cut or urethral damage, even if a clamp includes the foreskin with a part of glans or excess frenulum unnoticedly. CONCLUSION This technique is simple, quick, relatively bloodless operation with cosmetically good result. Morever it is quite safe against to amputation of glans, frenular short cut or urethral fistula formation.
Collapse
Affiliation(s)
- Halil Basar
- Department of Urology, Faculty of Medicine, University of Kirikale, Kirikkale, Turkey
| | | | | | | | | |
Collapse
|
13
|
Demirseren ME, Gokrem S. Circumcision in unqualified hands: a significant risk of complication. Plast Reconstr Surg 2004; 113:1090-2. [PMID: 15108927 DOI: 10.1097/01.prs.0000107735.19836.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Lidman D, Danielsson P, Abdiu A, Fåhraeus B. The functional result two years after a microsurgical penile replantation. Case report. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1999; 33:325-8. [PMID: 10505448 DOI: 10.1080/02844319950159325] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We describe the technique of microsurgical penile replantation and a case followed up after two years. The patient was a young man with decompensated schizophrenia who emasculated himself with a kitchen knife. A particularly good functional result was achieved including restoration of sensation in the penile shaft and in the glans, and return of erectile capacity.
Collapse
Affiliation(s)
- D Lidman
- Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden
| | | | | | | |
Collapse
|
15
|
Ozkan S, Gürpinar T. A serious circumcision complication: penile shaft amputation and a new reattachment technique with a successful outcome. J Urol 1997; 158:1946-7. [PMID: 9334645 DOI: 10.1016/s0022-5347(01)64187-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Ozkan
- Department of Urology, Inönü University, School of Medicine, Malatya, Turkey
| | | |
Collapse
|
16
|
|