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

Abstract

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.

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

“…Fortunately, the patient recovered his penile function, albeit, very gradually over three years. [18] Regarding other imaging modalities, predominantly Magnetic Resonance Imaging (MRI), previous work has only been focused on vascular abnormalities like priapism, Mondor disease, traumatic injuries including penile fracture and contusion, congenital anomalies in addition to penile malignancies. [31][32][33] Hence, current literature fails to provide adequate knowledge on the value of MRI in following clinical cases of penile amputation.…”

“…Among the studies reporting first-week post-operative Doppler evaluation, two investigations reported no vascularity in Doppler ultrasound [19,26], three studies did not provide any information of the post-operative Doppler findings [16,22,25] and one study reported that Doppler signal was positional, with complete loss of signal with adduction of the legs. [18] The rest of the studies reported adequate blood flow.…”

“…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.…”

Unusual Mechanisms of Penile Amputation

“…Some of the more common mechanisms include self-mutilation, domestic violence, trauma, and failed circumcision [2,4,6,7]. Less common injuries include boating accidents, animal bites, agricultural machinery accidents among others [8][9][10]. A series of penile amputations in ailand were maliciously performed in the 1970's by wives of unfaithful husbands [11].…”

Penile amputation after neonatal circumcision: a case report

“…Since the location, degree, and manner of injury can vary greatly, penile amputations constitute a complicated clinical entity. Surgical treatment is technically difficult, and the resultant physical and psychological consequences are important 4 . Now we present here a case report of penile amputation during neonatal circumcision with an unexperianced practitioner.…”