Treatment of A Completely Amputated Penis and Scrotum-A Case Report

Abstract

Among the traumas of the genitourinary tract, severance of the penis and scrotum is very rarely observed. Most cases of genital amputation involve the penis alone. The combined amputation of both penis and scrotum is rarely reported. The majority of penile amputation result from self-mutilation as a manifestation of a psychiatric disease, and a large percentage are performed during active psychotic episodes. In a few isolated cases, penis mutilation is the result of work accident, a jealous homosexual attack or war injuries. The unique vascular properties of the penis allow for astonishingly good results in a number of cases of genital amputation injuries. It is clear that microsurgical replantation is vital for good results with minimal postoperative complication. It presents the most physiology method of reconstruction, with a lower incidence of urethral stricture disease, skin loss and sensory impairment. We describe a case of complete amputation of the external genitals during an acute psychotic episode with successful replantation of the penis. One dorsal vein, two dorsal nerves and two dorsal arteries were repaired. However, skin necrosis of the scrotal area was noted postoperatively and was managed with bilateral pudendal-thigh flaps. Two months postoperatively, a urodynamic study showed a normal flow rate. The patient received ongoing psychiatric care. At 10 months postoperatively, he noted a morning erection. The case is discussed with respect to genital anatomy, duration of ischemia, operative strategy, postoperative management, postoperative complications, functional restoration, and psychiatric factors et al.