Penile Replantation for A Chinese Tourist Who Had Psychosis

Abstract

This is a report of a 37‐year‐old tourist who had schizophrenia and self‐mutilation. The complete cut of the lower penile shaft occurred in the early morning. He remained conscious with about 1.5 L blood loss. An emergency replantation was performed after immediate fluid resuscitation. Urethral anastomosis was done in a spatulated fashion through a Foley catheter. Corpus cavernosum were opposed in a watertight manner to secure haemostasis. Tension‐free anastomosis of the dorsal artery, deep dorsal veins, and dorsal penile nerve were performed under the microscope. Penile skin was closed loosely. Warm ischaemic time was 71–2 h after the amputation. Revascularization was satisfactory resulting in a pinkish glans penis. Mild venous congestion was noted at the ventral penile skin without sequel. Full psychosocial support and psychiatric care was commenced after the replantation. He himself pulled out the Foley catheter on day two. Afterwards he remained calm and cooperative. A normal urethrogram, an uroflow test of 18 mL/s, and a return of sharp and blunt sensation over the glans penis were documented two weeks postoperation when he was discharged back to Mainland China. The prognosis of his sexual function was unknown. Either complete resumption of sexual intercourse or second mutilation in psychotic patient had been reported in the literature.