CODE: 4 - Penile replantation - a case report
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Bartłomiej Gliniewicz ¹, Ireneusz Walaszek ², Andrzej Żyluk ², Andrzej Sikorski ¹

¹ Katedra i Klinika Urologii PAM w Szczecinie
² Klinika Chirurgii i Chirurgii Ręki PAM w Szczecinie

summary

Introduction. Penile amputation is a rare, traumatic event, mostly seen as a self-inflicted injury. About 90% of the patients suffering from this injury have psychiatric problems of which 51% is a decompensated schizophrenia. Penile replantation applies to all cases of amputated penis, providing that the amputated part is available or not completely destroyed. The replantation can be accomplished up to 16 hours or up to 24 hours at hypothermia. Since late seventies previous century microvascular repair has become the standard of care.

Objectives. We report on a case of multistep surgical management of an amputated penis.

Materials and methods. 23 years old man did an amputation of his penis about midnight. The penile amputated part was in good local condition. Because of patient's refusal of replantation, two hours from injury the wound was closed and perineal urethrostomy performed at urological department. 12 hours later he changed his mind. Second procedure, microsurgical replantation, was done 14 hours from injury, after transferring the patient to the hospital with microsurgical facility. After preparation for general anesthesia the following steps were done: debridement; identification of dorsal penile arteries, vein and nerves; stabilization of both ends with Foley catheter; urethral spatulation and anastomosis; reaproximation of cavernosal tunica albuginea; vascular anastomosis; drainage and skin approximation. 12 days later the patient was admitted to our department with sings of necrotic distal part of skin and corpus spongiosum. Debridement showed alive distal corpus cavernosum. A month later buccal mucosal graft was taken and transferred to the penile surface as first step in reconstruction of the urethra. Three months later second step of open urethroplasty took place - buccal mucosal graft tubularisation with sinking it under scrotal skin.

Results. Corpus cavernosum looks alive, penile skin is lost. Transferred buccal graft before tubularisation was alive, then sunk under the skin. The patient has superficial and deep feeling in his penis, though it is not complete. Erections are felt like changes in deep penile sensation rather than changes in penile tumescence.

Conclusions. Penile replantation is an example of successful microsurgical technique usage in urology. Penile stump status, ischemia time and proper surgical/microsurgical technique seem to influence the final anatomic and functional result most markedly. Even such a long time as 14 hours from injury does not preclude favorable surgical result.