Abstract
Background: Penile amputation is an emergency urologic condition requiring immediate attention in order to maximize functional outcomes. Unfortunately, there is limited experience and publication of case reports describing the successful replantation of penis after incomplete amputation, especially in facilities without adequate microsurgical tools and means. We hereby present a case of penile amputation caused by a mechanical grass cutter and a discussion of its surgical management. Case description: A 33-year-old Indonesian male presented to the emergency department with incomplete penile amputation six hours post injury. The patient has no prior medical history and presented with penile amputation due to a mechanical grass cutter trauma. He underwent immediate non-microsurgery reconstructive replantation of the penis, reattaching all visible vascular, corporal, and fascia layers. After replantation, the patient recovered well and showed preserved normal appearance and sensitivity of the penis. Subsequent Doppler ultrasound investigation revealed adequate arterial flow at the distal end of the anastomosis. The patient was discharged five days after surgery. Conclusion: In the absence of microsurgical tools and means, the use of non-microsurgical replantation with an at least 2.5x loupe magnification should be the choice of treatment in the case of incomplete penile amputation. The technique showed good outcomes involving adequate functional and cosmetic restoration.
Highlights
Penile amputation is an emergency urologic condition requiring immediate attention in order to maximize functional outcomes
E laboration of pre-operative patient care: including description of trauma protocol, asessment, and drugs administered at the time of patient arrival
The majority of penile amputations are due to self-mutilation due to psychiatric disorders, which accounts for about 87% of all cases
Summary
Any reports and responses or comments on the article can be found at the end of the article This version contains revision by means of enrichment and elaboration from the previous version. E laboration of pre-operative patient care: including description of trauma protocol, asessment, and drugs administered at the time of patient arrival This elaboration was done to answer peer reviewer’s request. E laboration of intra-operative findings: consisting of urethral condition, as well as the mention of dorsal penile veins and nerves injury along with corporal bodies This part is elaborated per peer reviewer’s request. E nrichment of technique: including the mention of the use of a 2.5x loupe magnification, vicryl 5/0 continuous suture to repair corporal bodies and 4/0 vicryl interrupted suture to repair fascia and skin This part is elaborated to answer peer reviewer’s questions
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