PTU - Polskie Towarzystwo Urologiczne

Successful reanastomosis of almost complete amputated segment of penis without microsurgical technique
Artykuł opublikowany w Urologii Polskiej 2007/60/3.


Ryszard Jankiewicz
Department of Surgery, St. Walburg's Hospital, Nyangao, Tanzania

słowa kluczowe

penis, amputacja, zespolenie bez wykorzystania technik mikrochirurgicznych


An almost completely amputated penis was successfully reattached, 16 hours after the injury, in a small rural hospital without microsurgery. This case demonstrates that a successful outcome is possible using standard surgical procedures that are often the only
available treatments in developing countries.


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 [1]. 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].

Case Report

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 sutured.

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 surgery.


  1. Jezior J R, Brody J D, Schlossberg S M: Management of Penile Amputation Injuries. World J. Surg 2001, 25, 1602-1609.
  2. Morey A F, Metro M J, Carney KJ et al: Consensus on genitourinary trauma: external genitalia. BJU Int 2004, 94, 507-515.
  3. Darewicz B, Galek L, Darewicz J et al: Successful microsurgical replantation of an amputated penis. Int Urol Nephrol 2001, 33, 385-386.
  4. Baudi G, Santucci R: Controversies in the Management of Male External Genitourinary Trauma. J Trauma 2004, 56, 1362-1370.
  5. Kochakarn W: Traumatic amputation of the penis. Br J Urol 2000, 26, 385-389.

adres autorów

Ryszard Jankiewicz
St. Walburg's Hospital, Nyangao
P. O. Box 1002 Lindi, Tanzania
tel. +255 717 404540