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

Abstract

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.

The role of Doppler ultrasound after penile replantation surgery: A case report and a systematic review of the literature

“…Similar to the reports mentioned earlier, adequate deep and superficial arterial blood flow was revealed at the distal end of the penis. [20] In contrast to the clinically desirable findings reported by this study, a year earlier, in 2019, Elmaraghi et. al.…”

“…All of the included studies were case reports of penile amputation with different causes, including assaults [15][16][17], accidents [18][19][20], circumcision complication [21], or self-mutilation induced by drugs [4] and psychosis episodes. [22][23][24][25] One study reported self-amputation in a male patient without mentioning the underlying cause.…”

Traumatic Penile Amputation Post Circumcision: A Series of 3 Cases

“…In situations of penile glans amputation or when instrumentation for microscopic surgery is not available, macroscopic replantation may be another reconstructive option to salvage the amputated penis [2] [12]. The first two patients presented had macroscopic replantation of the amputated glans and the penis with a favorable outcome with regards to voiding function and sensation during 8 months period of follow-up.…”

“…Penile stump replantation without repair of dorsal vessels of the penis could be considered as a graft. Thus the replanted graft will survive by imbibition by obtaining nutrients from the adjacent graft by diffusion [12]. The penile graft is successful because the dorsal and urethral arteries serve as an excellent source of blood supply to the corpus spongiosum and the glans.…”