Meticulous anatomic microreplantation for complete penile amputation: a report of 4 cases

Abstract

Objective To improve the early management of penile amputation injury by analyzing and summarizing our microreplantation experience of 4 cases of complete penile amputation. Methods Clinical data of 4 patients with complete penile amputation admitted to our hospital from March 2018 to October 2022 were collected, and their related clinical features, microsurgical procedures, post-operative treatment and follow-up outcomes were retrospectively analyzed. Results Meticulous anatomical microreplantation was successfully performed on all the 4 patients. Two of them received successfully bilateral penile dorsal arteries anastomosis, and the other two got only one dorsal artery anastomosis. All patients completed anastomosis of deep dorsal penile vein, and 3 of them had superficial dorsal vein anastomosis. Anastomosis of 4~6 dorsal nerves on both sides of the back of the penis were completed in all the patients. The operation time ranged from 6.5 to 7.5 h, with an average of 6.9 h. The warm ischemia period was 1~4 h, averagely 1.9 h. During the follow-up, 3 cases obtained successful penis replantation, although 2 of them had partial necrosis of foreskin, which healed naturally after 2~3 months. These 3 patients had normal urinations after operation, and had an erectile hardness score of 3~4 in 3~6 months after operation, with satisfactory self-reported recoveries. Conclusion For the patients with short warm ischemia period after complete penile amputation, microreplantation should be carried out as soon as possible in order to obtain satisfactory appearance and functional recovery of the penis.

Keywords

• penile amputation
• penile injury
• microsurgery
• replantation
• vascular anastomosis