Successful replantation of an amputated penis: a case report and review of the literature

Successful Pediatric Penile Replantation Following Amputation During Ritual Circumcision: A Case Report and Literature Review

BACKGROUND Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. CASE REPORT We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. CONCLUSIONS Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes.

Successful Microsurgical Replantation of Amputated Penis: A Case Report and Review of Literature

This study aims to explain microscopic replantation in a rare case of a wholly amputated penis after prolonged ischemia. A 36-year-old patient underwent microscopic replantation of the penis after 9 hours. The penis was completely amputated due to self-mutilation. Microvascular replantation was performed after pre-operative preparation. On the second day after surgery, congestion was observed in the penis, and three sessions of leech therapy were conducted each time the leeches were placed for 30 minutes and then detached by themselves. The patient was referred to a psychiatrist to continue treatment after discharge from the hospital. Penile amputation is a rare situation and has different causes. There are various treatments to repair the amputated penis, which are both microvascular and microvascular. The microsurgery methods have shown the best results. In the present case, due to microsurgical artery repair and the early start of leech therapy, there was limited and predictable necrosis in the area of the penoscrotal junction flap, which underwent debridement and skin graft. Complete amputation of the penis is a rare phenomenon. Efforts should be made to perform the replantation surgery as soon as possible. The venous outflow is an essential factor in the success of penile re-implantation, and completely restored vascular and sensory function in this case. Early initiation of psychological care to control underlying disease leads to further cooperation of the patient to handle complications and avoid the recurrence of self-injury.

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

Background: Penile amputation is an emergency urologic condition requiring immediate attention in order to maximize functional outcomes. Unfortunately, there is limited experience and publication of case reports describing the successful replantation of penis after incomplete amputation, especially in facilities without adequate microsurgical tools and means. We hereby present a case of penile amputation caused by a mechanical grass cutter and a discussion of its surgical management.

Case description: A 33-year-old Indonesian male presented to the emergency department with incomplete penile amputation six hours post injury. The patient has no prior medical history and presented with penile amputation due to a mechanical grass cutter trauma. He underwent immediate non-microsurgery reconstructive replantation of the penis, reattaching all visible vascular, corporal, and fascia layers. After replantation, the patient recovered well and showed preserved normal appearance and sensitivity of the penis. Subsequent Doppler ultrasound investigation revealed adequate arterial flow at the distal end of the anastomosis. The patient was discharged five days after surgery. 

Conclusion: In the absence of microsurgical tools and means, the use of non-microsurgical replantation with an at least 2.5x loupe magnification should be the choice of treatment in the case of incomplete penile amputation. The technique showed good outcomes involving adequate functional and cosmetic restoration.

Successful penile replantation after macroscopic repair using vein blood-letting therapy

Although penile amputation is a rare injury, it may occur caused by self-mutilation with psychiatric disturbances and sexual need, or due to accidents, iatrogenic injuries or revenge and marriage breakdown. A case of successful penile glans replantation by macroscopic repair using vein blood-letting therapy is presented. This case report shows the surgical procedure and postoperative care which may be critical for successful replantation.

Two cases of successful microsurgical penile replantation with ischemia time exceeding 10 hours and literature review

Traumatic penis amputation is a urological emergency. Although repair techniques have been well described in literature, failure of replantation and its causes are poorly understood and reported. The aim of this study is to evaluate the treatment and prognosis of microsurgical replantation of penile amputation with a relative long-term ischemia, and review related literatures to summarize relevant clinical experiences. We report two cases of penile amputation and microsurgical replantation performed in our hospital in August 2016. In the first case, the patient was injured by sharp scissors due to family conflict, while in the second case, it was a mechanical injury. For both cases, microsurgical approaches were adopted. After the microsurgical replantation, both the patients recovered well and showed normal urination, erectile function, return of sensations and satisfactory cosmetic appearance. With the development of microsurgical techniques, the successful re-anastomosis of blood vessel and nerve can increase the survival and functional recovery of the penis even in cases exceeding 10 hours of ischemia. This provides greater possibility of graft survival with minimum complication.

Success of Penile Replantation Using Combination of Cialis, Hyperbaric Oxygen, and SPY Technology

Objective: There are very few studies reporting the techniques utilized in penile replantation. Of those in literature, many agree that the use of microvascular technique results in better outcomes. The most common complications are skin necrosis and venous congestion, which are even higher in replants without arterial supply. Methods: This study describes a case of self-inflicted penile amputation treated with microsurgical replantation and managed postoperatively with hyperbaric oxygen therapy and Cialis (tadalafil), and SPY angiography. The penile replant had extensive skin necrosis, which prevented a sufficient clinical evaluation of the replanted penis. Serial SPY angiography was performed to assess tissue viability, following hyperbaric oxygen therapy and Cialis treatment. Results: SPY angiography was critical to the decision making of the operating team in the management of this case of penile replantation. Conclusions: The use of SPY angiography prevented the patient from undergoing revision amputation and allowed for a safe and successful penile replantation.

Functional penile replantation after traumatic avulsion amputation below the pubis: A case report

Penile amputation is a rare injury with significant posttraumatic ramifications. We present a case of successful immediate replantation after traumatic penile avulsion in a 52-year-old male patient. The patient reported his penis was caught in machinery during a boating accident, and avulsed at the level of the pubis. Immediate replantation of this proximal avulsion injury with no suitable proximal arterial stumps required transfer of the superficial inferior epigastric artery for arterial inflow. One artery and two veins were repaired. The urethral injury was found to be immediately distal to the urethral sphincter in the membranous portion, and repaired primarily. Urinary diversion was performed with a suprapubic catheter until the repair had healed. The postoperative course was complicated by less than 10% skin necrosis requiring skin grafting. At three years follow up, the patient has a penis with normal urinary function and is able to obtain erections with pharmacologic aids. Avulsion should not preclude penile replantation, which may have acceptable functional and esthetic results.

A successful microsurgical approach to treating penile amputation following genital self mutilation

We present the case of a 33-year-old male who presented to the Emergency Department having amputated his penis as a result of auditory hallucinations triggered by cannabis use. A successful microsurgical technique involving anastomosing the individual structures of the penile shaft enabled a successful cosmetic and functional outcome including restoration of erectile function.

Successful Second Microsurgical Replantation for Amputated Penis

Penile amputation is a rare emergency, but the best method for its repair is required due to the organ's functional and societal role. Since the first successful microsurgical replantation of the amputated penis, microsurgical techniques have matured and become the standard treatment for the penile replantation. However, the successful second microsurgical replantation for amputated penis has been rarely reported. We present the case of a 40-year-old man with schizophrenia who had a past history of penile self-mutilation and successful replantation at another hospital 2 years ago. After stopping oral medication for schizophrenia, he again cut his penis with a kitchen knife. We successfully replanted the amputated penis by anastomosing both circumflex arteries, the superficial dorsal vein, and the deep dorsal vein using microsurgical techniques. Postoperatively, the foreskin of the replanted penis gradually developed partial necrosis, requiring surgical debridement. The aesthetic and functional results were satisfactory and retrograde urethrography showed no evidence of leakage and stricture of the urethra. Although skin necrosis after penile replantation has been reported as an unavoidable process owing to the nature of injury, the rate would be higher after secondary replantation because of scar formation due to the previous operation. Therefore, our case of successful secondary replantation suggests that skin necrosis would be a predictable postoperative complication and the debridement timing of the devitalized foreskin should be closely monitored, and also secondary amputation is not a contraindication of replantation.

Phalloplasty: A Review of Techniques and Outcomes

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.

Traumatic penile amputation in a 15-year-old boy presenting late in northwestern Nigeria

Traumatic penile amputation is a serious urological emergency, although rare whenever it happens, there is a need to refer the patient early to urologist within 24 h, with the stump wrapped in saline; unfortunately, our patient presented late and as such could not benefit from penile reimplantation.

Penile amputation and successful reattachment and the role of winter shunt in postoperative viability: A case report and literature review

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-year-old patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter's shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis.

Complete transection of the urethra and corpora cavernosa: a complication after laparoscopic repair (TEP) of an inguinal hernia

Complete transection of both corpora cavernosa and the urethra is a very rare condition in urology. We report the case of a 59-year-old man with complete transection of the corpora cavernosa and the urethra during a laparoscopic repair of a recurrent inguinal hernia.

Surgical management of traumatic penile amputation: a case report and review of the world literature

INTRODUCTION

There 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.

AIM

To report on self-inflicted penile amputation and comment on its surgical management and review current literature.

METHODS

A 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 MEASURES

To 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.

RESULTS

We 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.

CONCLUSION

We 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.