Arch Hand Microsurg.  2019 Dec;24(4):394-401. 10.12790/ahm.2019.24.4.394.

Replantation of the Completely Amputated Adult Penis: Two Case Reports Using Microsurgical Technique

• Lee DW
• Hong SW
• Kim JH

• KMID: 2464477
• DOI: http://doi.org/10.12790/ahm.2019.24.4.394

Abstract

Traumatic penile amputation is a rare but catastrophic event, so all possible attempts should be made for salvage. Recent use of microsurgical methods have the potential to reduce complications, but to date, most reported surgical successes have focused on survival and were not complication-free. To restore baseline penile function, normal anatomic structure must be re-established. We have attained flawless anatomic replantation of the adult penis and describe two case reports where complications were eliminated by a microsurgical approach. One patient was a 38-year-old schizophrenic, and the other was a 43-year-old chronic alcoholic. Under microscopy, normal function and aesthetics were restored, without complications. Rather than viability, the most critical issue is a return to normal status. Microsurgical replantation is thus the treatment of choice in instances of penile amputation, and is aimed at restoring normal anatomy and function.

Keyword

Penis; Replantation; Amputation; Microsurgery

MeSH Terms

Adult*
Alcoholics
Amputation
Esthetics
Humans
Male
Microscopy
Microsurgery
Penis*
Replantation*

Figure

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  Fig. 1 (A) Anastomosis of urethra and corpus spongiosum was performed with Z-plasty and 3-layered suture technique. (B) Anastomosis of cavernosal artery which is situated in the center of corpus cavernosum.

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  Fig. 2 Schematic illustration of operative method (1: cavernosal artery or deep artery of penis, 2: superficial vein beneath the dartos fascia, 3: dorsal penile nerves, 4: superficial dorsal vein of penis, 5: deep dorsal vein of penis, 6: dorsal arteries of penis, 7: circumferential vein or circumflex vein, 8: fibrous capsule of corpus spongiosum, 9: urethral mucosa, 10: urethral muscular layer). Cited from the article of Kim et al. (J Korean Soc Plast Reconstr Surg 2004;31:127-32)3.

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  Fig. 3 (A) The proximial penile stump was wrapped with rubber nelaton catheter for bleeding control. (B) The amputated penis. (C) Postoperative appearance of the penis at 28 days.

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  Fig. 4 A retrograde urethrogram taken at 28 days shows no evidence of stricture or fistula.

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  Fig. 5 (A) Nocturnal penile tumescence test (NPT) checked at 3 weeks showed 3 episodes of poorly sustained and rigid nocturnal erections and mean erection duration was 9 minutes. (B) NPT checked at 3 months showed two episodes of well-sustained, completely rigid nocturnal erections and mean erection duration was 45 minutes.

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  Fig. 6 (A) Preoperative photography of complete amputated penis. (B) Postoperative appearance of the penis at 30 days.

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  Fig. 7 A retrograde urethrogram taken at 30 days shows no evidence of stricture or fistula. POD: postoperative day.

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  Fig. 8 (A) Nocturnal penile tumescence test (NPT) checked at 3 weeks showed 2 episodes of poorly sustained and rigid nocturnal erections and mean erection duration was about 12 minutes. (B) NPT checked at 5 months showed five episodes of well-sustained, completely rigid nocturnal erections and mean erection duration was 101 minutes.

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