Traumatic Penile Amputation Research Articles

Traumatic penile amputation managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria: a case series

BackgroundTraumatic penile amputation is a rare surgical emergency and a cause of anxiety and psychological distress to patients, spouses, or parents, especially when it occurs in children. Several mechanisms are involved in penile amputation and the management options also vary. We report two cases of penile amputation that our institution handled in the past year to draw attention to the risks associated with firearm confrontations and grinding machines as causes of genital injuries. In a similar vein, we look over the literature for management options.Case presentationIn the first case, a grinding machine resulted in an isolated total penile amputation of a 6-year-old boy. In contrast, the second patient was a 25-year-old man who had bilateral testicular injuries and near-total penile amputation as a result of gunshot injury as part of polytrauma. Both patients had a history of profuse bleeding from the penile stump associated with severe pain. Both patients were resuscitated and subsequently underwent emergency wound debridement and stump refashioning/meatoplasty. The first patient had a satisfactory outcome and was discharged home on follow-up visits while the second patient died from overwhelming sepsis with pulmonary embolism as a differential.ConclusionPenile injuries may increase in tandem with civilian firearm-related incidents. Similarly, grinding machines are an important cause of penile injuries. In emergencies, wound debridement followed by stump refashioning is an appropriate treatment option.

Subtotal traumatic penile amputation of unknown origin in a canine

AbstractCases with a fracture of the os penis in dogs have been reported rarely, and to the authors’ knowledge, traumatic penile amputation has only been reported once. The dog presented in this case report sustained subtotal traumatic penile amputation of unknown origin. Before the presentation, the dog had been in a boarding facility, where no trauma was witnessed. The patient presented with haematuria, discharge from the prepuce, and lethargy. Upon examination, traumatic subtotal penile amputation was diagnosed, and a complete blood count revealed severe regenerative anaemia. Surgical debridement was performed, and the wound healed by second intention. During the recovery period, a urinary catheter was placed to aid in preventing urethral stenosis. Though the animal sustained extensive trauma to its genitals and subsequent anaemia, it survived with a good quality of life and acceptable urinary function.

Self-inflicted traumatic penile amputation: A case of Klingsor syndrome

Klingsor syndrome, also known as self-inflicted traumatic penile amputation, is a rare condition that often occurs in individuals who suffer from psychiatric disorders, religious preoccupations, substance abuse, and societal neglect or isolation

Penile glans amputation and caverno-spongiosal disjunction following a dog bite: a case report

 Traumatic penile amputation is a rare surgical emergency. Successful surgical reimplantation is very challenging even in the hands of experience surgeons. We report the case of 13-year-old boy who presented with traumatic penile amputation with complete urethral section and caverno-spongiosal disjunction. This resulted from a dog bite injury which occurred 2 hours before consultation. Following primary and secondary surveys, the emergency management consisted of resuscitation, broad spectrum antibiotics and tubulisation of the sectioned urethra. Urethroplasty and subsequently a caverno-spongioplasty were then performed. The post-operative follow-up was uneventful and immunisation against rabies was done. Erection with the catheter in place was normal upon control. Patient was re-evaluated 8 years later and had a cosmetically acceptable penis and void with a good urinary stream. Microscopic penile reimplantation remains the gold standard though challenging and unavailable especially in resource limited settings. However, non-microscopic genital reconstruction is possible with satisfactory cosmetic and functional outcomes.

Traumatic Penile Amputation by a Jealous Spouse: A Case Report

Traumatic Penile Amputation by a Jealous Spouse: A Case Report

First report of successful refashioning using the Bracka technique after complete glans penile amputation from a dog bite injury in a child.

Traumatic penile amputation and re-implantation or refashioning is scarcely reported in the literature. We present our case, the first report of successful glans refashioning in an 11-year-old boy, using the Bracka (refashioning) technique after complete glans penis amputation from a dog bite injury, with unsuccessful re-implantation due to the nature of the injury, during the dog bite. We elaborate on the process, technique, as well as the satisfactory postoperative results of the abovementioned procedure.

020 Surgical Management of Traumatic Penile Amputation

020 Surgical Management of Traumatic Penile Amputation

Self Amputation of Penis and Right Testis – A Case Report

Penile amputation is a rare urologic emergency but carries major functional and psychological consequences in regard to patient's overall quality of life. There is a paucity of case reports of traumatic penile amputation during circumcisions; however, most of the cases reported with self-mutilation are a result or severe substance-induced psychosis or underlying psychiatric disorder . We herein describe a case that resulted in a complete self-amputation of the patient's penis under the influence of alcohol and management methods when the amputated part of the penis is not available

Traumatic penile amputation in a 15‐year‐old boy presenting late in northwestern Nigeria

Key Clinical MessageTraumatic penile amputation is a serious urological emergency, although rare whenever it happens, there is a need to refer the patient early to urologist within 24 h, with the stump wrapped in saline; unfortunately, our patient presented late and as such could not benefit from penile reimplantation.

Total Phallic Reconstruction Using the Radial Artery Based Forearm Free Flap After Traumatic Penile Amputation

IntroductionAlthough genital injuries in civilian centers are rare, the scenario is completely different in the battlefield. If the penile distal stump is not adequate for primary reimplantation or it cannot be found, then delayed penile reconstruction needs to be considered. AimTo report a single-center experience with total phallic reconstruction using radial artery based forearm free flap (RAFFF) after penile traumatic loss. MethodsWe retrospectively reviewed the clinical records of 10 patients who underwent total phallic reconstruction with the use of the RAFFF from September 2001 through August 2015 after traumatic amputation of the penis. Main Outcome MeasuresPatients' baseline features, surgical outcomes, complications, and satisfaction are reported. ResultsThe average age at the time of penile reconstruction was 36 years (range = 27–52 years). The causes of penile loss were self-amputation owing to an acute schizophrenic episode (n = 2), road traffic accident (n = 3), blast injury (n = 3), donkey bite (n = 1), and Fournier gangrene (n = 1). The average time from the trauma to reconstruction with the RAFFF was 7 years (range = 2–15 years). The urethral stump was adequate for primary anastomosis, with phallic neourethra construction in six patients. The remaining patients had complete avulsion of the penis and were voiding though a perineal urethrostomy. In consequence, they required a two-stage urethroplasty. An acute arterial thrombosis of the microsurgical anastomosis occurred in two patients and was managed successfully with immediate exploration. A neourethra stricture and fistula occurred in one patient, which needed revision. All patients who underwent complete urethral reconstruction could void and ejaculate from the tip of the phallus. After a median follow-up of 51 months (range = 1–114 months), all patients were satisfied with the size, cosmetic appearance, and sensation of the phallus. Six patients underwent inflatable penile prosthesis implantation and could engage in penetrative sex. However, revision surgery was needed in three patients (infection, n = 2; mechanical failure, n = 1). ConclusionDespite the high incidence of postoperative complications and the possible need for multiple operations, in expert hands and in large-volume centers, penile reconstruction with the RAFFF after traumatic loss of the penis yields excellent results and allows patients to regain sexual and urinary functions.

Surgical management of traumatic penile amputation: a case report and review of the world literature.

IntroductionThere is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature.AimTo report on self-inflicted penile amputation and comment on its surgical management and review current literature.MethodsA 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue.Main Outcome MeasuresTo review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes.ResultsWe report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements.ConclusionWe review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53.

Traumatic Penile Amputation: A Case Report and Acute Management

Traumatic penile amputation is a rare clinical situation. We report a case of self-inflicted penile amputation in a patient with psychosis and discuss the surgical management. Acute management largely entails stabilization in preparation for surgery, where options include replantation of the amputated penis versus closure of the remaining stump, depending on the viability of the penis. Although replantation is the best option, it is often not possible and thus closure of the wound is acceptable

Successful penile replantation using loupe magnification

Traumatic penile amputation is a rare condition requiring urgent surgical consultation with almost immediate surgical intervention. Although seen in both paediatric and adult populations, the majority are seen in the latter age group. These injuries are penetrating in nature, usually occur with the organ flaccid and most are self-inflicted by mentally unstable patients. Currently replantation involves meticulous microsurgery to reduce skin, urethra and graft loss, but these complications may still occur. Non-microsurgical techniques have been utilised with good post-operative outcomes. This report describes penile replantation in a 24-year old mentally challenged patient using 4.5× loupe-magnification to restore a functional, fully erectile penis without tissue loss and a 20-year problem free follow-up.

Primary anastomosis of the traumatically amputated penis

Penile amputation is an uncommon condition for which immediate surgical replantation is warranted. This work aimed to represent intervention and management for an amputated penis by replantation and reconstruction. A 23-year-old man presented with traumatic penile amputation for 2 h where the penile proximal part was 1 cm far from the pubis. Replantation included end-to-end anastomosis of the urethral mucosa over a catheter, approximation of the corpus cavernosum and tunica albuginea, anastomosis of the deep dorsal vein, dorsal nerve, both dorsal arteries and superficial dorsal vein. At day 5 post-operatively, the replanted penis had preserved capillary filling. The catheter was removed at day 11, where the patient urinated smoothly. The preliminary cosmetic appearance was satisfactory with frequent morning erection, reported night emission twice within the first month post-operatively. Sensation was preserved in the distal anastomosed stump. It is concluded that meticulous microsurgical technique decreases the possibility of skin loss and increases the chance of erectile function.

Lower Abdominal Flap Phalloplasty in Older Children for Congenital and Acquired Diseases

PURPOSE Phalloplasty with lower abdominal flap (PAF) was introduced in infants as a temporary procedure for penile agenesis (ESPU 2002, 2005 & 2007). We would like to present indications and outcomes of PAF in older children affected by congenital or acquired diseases. PATIENTS AND METHODS From November 2005 to July 2007, 6 patients, 4 to 14 years old (overage 9 years), received PAF for phallic-replacement. Two patients were affected by penile agenesis, 2 by DSD, and 2 by iatrogenic or traumatic penile amputation. Total urethral reconstruction has been simultaneously carried-out in 3 cases. Partial urethroplasty has been utilized in the remaining 3 making a penoscrotal urethrostomy. RESULTS After 3 to 22 months, phalloplasty was successful in all, but one had a dorsal penile suture dehiscence, resulting in an epispadiac appearance. The 3 total urethroplasties failed for untreatable meatal/distal-penile urethral stricture; perineal or scrotal urethrostomy were the salvage procedures. The 3 partial urethroplasties are working properly. CONCLUSIONS In high-specialized centers, microsurgical-transferred radial-forearm-flap phalloplasty, achieves good results in adults and has to be considered the technique of choice. Microsurgical phalloplasty is a team-procedure, not recommended before age of 15 years. In comparison, PAF is simpler, performed by a single surgeon, and has anyway shown satisfactory outcomes. For patients under 15 years of age or when a specialized team is not available, the questions are: is PAF justified? Do social and psychological reasons validate PAF that may be temporary or just cosmetic phalloplasty? Might auto-manipulation or special devices achieve an increase in length, with the expectation that new phallus might reach an acceptable size to insert of a penile prosthesis?

Six years follow-up of a penis replantation in a child

Total amputation of the penis is very rare in a child. This article presents a case of a traumatic penile amputation at the base of the perineum, with scissors, in a 4-year-old child. Six hours after the aggression, the penis was replanted. Three weeks after the intervention, except for skin necrosis, the results were excellent. Six years afterward, this child has done very well from pediatric, psychological, urological, and plastic surgery points of view. Sensibility and erections are present and normal. Longer follow-ups particularly during puberty are necessary. Total amputation of the penis is a very rare accident in a child. Partial lesions are more common, particularly during circumcision. As in adult cases, replantation of the penis in a child needs a clean section by scissors or a knife, a correct conservation of the penis (in ice but without direct contact), and a short period between the lesion and the surgical procedure. All these conditions explain that very few cases are reported in the literature. We present a case of amputation of the penis in a 4-year-old child, with good results 6 years afterward.

Use of buccal mucosa to simulate the coronal sulcus after traumatic penile amputation

Traumatic penile amputation is a rare but catastrophic complication of newborn circumcision, usually involving a portion of, or the entire, glans penis. Emergent reimplantation is necessary to prevent glans loss. However, loss of the coronal sulcus might occur despite successful reimplantation, resulting in a cosmetically unacceptable appearance. We report such a case involving a newborn who suffered partial penile glans amputation and loss of the coronal sulcus after reimplantation, successfully treated with buccal mucosa grafting.

Rare Complication of Circumcision: Penile Amputation and Reattachment

We report a case of traumatic penile amputation which occurred accidentally during a ritual circumcision in a 10-year-old boy. A successful penile reattachment was accomplished. Additionally, we discussed the causes and prevention of this condition.