AB136. Successful penile replantation following penile self-amputation: case report and literature review

Objective: Penile amputation is an uncommon injury resulting from self-mutilation, felonious assault, or accidental trauma. Although it is uncommon and rarely fatal, penile amputation is a challenging injury for Urologist to treat. Many factors should be taken into consideration of proper treatment. In this kind of patients, the mental and physical conditions are usually complicated. Rapid stabilization is very important to afford the appropriate time and specialization for surgical success. Currently, many reconstructive techniques provide an excellent outcome for penile replantation. We reported a case of soft palate squamous cell carcinoma under palliative chemotherapy who amputated his penis at the base with a sharp blade due to severe depression.

Methods: A 66-year-old man with soft palate squamous cell carcinoma, pT2N0M0, post surgery and local recurrence, was under palliative chemotherapy now. Two days before this emergent episode, he was just admitted due to dyspnea and electrolytes imbalance. He decided to discharge against advice before completing the treatment. After lunch, he locked himself in the bathroom and used kitchen knife to mutilate his penis. He was brought to our emergency department by his family. A clinical examination found a bloody and destroyed penis. One small piece of penile appendage was connected with actively bleeding penile stump by one side of prepuce. The exploratory surgery showed a complete transection of corpus cavernosum, corpus spongiosum, and urethra. A 14-French silicon catheter was threaded through the glans and aligned with the proximal urethra. We began with interrupted 4-0 Vicryl sutures in a 360-degree fashion to connect urethra. Interrupted 4-0 Vicryl sutures were placed from ventral side of the tunica albuginea of the corpus spongiosum. Till the dorsal aspect of amputated penis, we carefully applied tension-free, interrupted 4-0 Vicryl sutures to reapproximate the tunica albuginea of the corpus cavernosum. A pressure dressing was placed around the anastomosis wound. After surgery, the patient was taken daily wound care.

Results: Penile amputation is a rare urologic emergency. The actual incidence of penile amputation is rare. The first documented case of macroscopic penile replantation was reported in 1929 by Ehric. Since then, there have been gradual rise of traumatic penile amputation with 87% of cases reported associated with an underlying psychotic disorder. A review of the literature revealed at least 30 cases of penile auto-amputation with successful replantation since 1970. Treatment of penile amputation includes three basic forms: surgical replantation of the amputated penis, tailoring of the remaining penile stump, or total phallic replacement. Many factors will lead to positive final results: the degree of injury, type of injury, duration of warm ischemia, the equipment used, and experience of the operative team. Most outcomes reported till now were acceptable.

Conclusions: Penile amputation is an extremely rare urology emergency. We reported that a macrosurgical technique without microsurgical venous repair is able to restore normal urinary function in a case with penile amputation and complete urethra injury and partial corpus spongiosum injury.

Keywords: Penile self-amputation; genital self-mutilation; penile replantation; external genital injury