Penile amputation is a rare injury that usually occurs as a result
of an assault, complications of circumcision, self-inflicted
trauma due to psychiatric disorders, an accident either industrial
or domestic, or an animal bite. The penis should be reattached
as soon as possible and within 24 hours. If immediate surgery is
impossible, the organ should be preserved at a temperature close
to 0 Centigrade . The best results for reattachment are obtained
using microsurgical techniques for anastomosis of the
dorsal arteries, veins and nerves following the suturing of the
corporal structures and urethra [2,3]. Reattachments using standard
surgical procedures have been reported but complications
are more frequent [4,5].
A 30 year-old man was admitted to the hospital in the morning
hours, conscious and in generally satisfactory condition,
with an almost complete amputation of the penis in its middle.
The distal part was hanging by a strip of skin and subcutaneous
tissue 2 cm long and 2 mm thick on the urethral side (Fig. 1).
As well, the patient had multiple deep cut wounds to the head
with two fractures of the right parietal bone, multiple deep
cut wounds to the chest and both shoulders with a cut-off left
accromial process. There were also multiple deep cut wounds on
the lower extremities.
The injuries were from a machete attack by a humiliated husband
and his supporters. The attack occurred 16 hours before
admission to the hospital. The patient was immediately sent to
the surgical theatre and was prepared using Ketamine IV anesthesia.
The smoothly cut surfaces of the penis were cleaned with
water and a solution of Betadine with liquid surgical soap followed
by normal saline. A Foley catheter, No. 18, was inserted into
the urethra and the urethra was sutured using interrupted sutures
(catgut chromic 4/0). Next, the corpus spongiosum was sutured
(chromic 4/0) using interrupted sutures. The fibrous fascia
surrounding both corpus cavernosum was sutured with Vicryl
3/0. Lastly, the skin was sutured using interrupted sutures (Vicryl
3/0). Two small soft rubber drains were inserted into the subcutaneous
space. None of the penile blood vessels or nerves was
The cut-off acromion was fixed using a wire loop and all deep
wounds were sutured.
In the post-operative period, the patient received Chloramphenicol
and Metronidazole 500 mg TID each, Diclofenac 50 mg
TID and Aspirin 300 mg TID.
The post-operative period was surprisingly without incident.
On the first day, the distal part of the penis was warm. On the
third day, the drains were removed. By the fourth day it was possible
to see the subcutaneous veins filled with blood. On day seven,
all sutures were removed.
During the first two post-operative weeks, the patient's temperature
was elevated (38 to 38.5oC) on three occasions. The wound
had healed well (Fig. 2) with one small area discharging
a drop of pus. There was some purulent discharge from the urethra.
The Foley catheter was removed post-operative day 21. After
its removal, the patient was able to void without pain. The patient
was discharged on post-operative day 24.
On examination two weeks later, the wound line was slightly
irregular but without signs of infection. There was a small purulent
discharge from the urethra. Micturition was not difficult. The
patient felt slight pain when the wound area was compressed.
An examination three months post-operatively found a smooth
line of healed skin at the wound site (Fig. 3). The patient reported that there was no urethral discharge and that he was able
to achieve an erection without unpleasant sensations. He will be
monitored further in order to discover any possible late complications.
Although penile amputation is a rare injury, we have had
three cases in our hospital in the last five years. The first was
a young man who had been completely castrated including the
penis and scrotum. He was admitted without the amputated
parts and it was possible to only do debridement. After healing,
he was able to void without difficulty. The second case was a five
year-old boy with an infected 1 cm stump of his penis due to
complications from circumcision done under septic conditions.
In the developing world, including most of Africa, a patient
with a traumatic penile amputation faces a difficult outcome.
Immediate transport to a hospital usually takes a long time due
to poor roads and long distances. Furthermore, when the patient
reaches the hospital there is little chance for microsurgery due to
a lack of technology and expertise. The only solution available
under these circumstances is to use typical instruments and sutures.
Our case demonstrates that a satisfactory outcome is possible.
In the developing world most patients with an amputated
penis do not have access to microsurgical techniques. Our case
demonstrates that they can be successfully treated using conventional