Microsurgical Penile Replantation: Case Report

Aluora Kenneth (1) , Khainga Stanley (1), Nang’ole Ferdinand (1) , Ikol James (2), Were  Andrew (1), Gathariki Mukami (1), Ajujo Martin (1), Malungo Nang’andu (1)

1.Thematic Unit of Plastic Surgery, Department of Surgery, School of Medicine, University of Nairobi. P.O. Box 19679 – 00202 Nairobi, Kenya.

2.Kenyatta National Hospital. P. O. Box 20723 – 00202 Nairobi, Kenya

Correspondences toDr. Aluora Kenneth; email: aluorakenneth@gmail.com

Received: 12 Jan 2021; Revised: 14 Nov 2021; Accepted: 26 Nov 2021; Available online: 29 Dec 2021

Abstract

Penile replantation is uncommon, with most data being case reports or case series. In our setting, replantation is fairly new despite penile amputations being common as a result of marital disputes and assault. Replantation remains the most ideal option for managing these cases. We present a case of penile replantation in a 17-year-old male after traumatic amputation following an assault. Some of the challenges we encountered included loss of skin and the glans with formation of a hypospadias. Nevertheless, the outcome was satisfactory with return of sensation and erection.

Keywords: Penile amputation, Penile replantation, Microsurgery, Penile reconstruction, hypospadias

 

Ann Afr Surg. 2022; 19(2): 130-134

DOI: http://dx.doi.org/10.4314/aas.v19i2.12

 

Funding: None.

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License

Introduction 

Amputation of the penis is traumatizing to the patient, spouse, and family. Most cases of penile amputations documented result from self-mutilation, also known as Klingsor syndrome (1). Other causes include assault commonly by spouse, accidental amputation, circumcision, and iatrogenic (2,3). Various challenges facing penile replantation in developing countries include loss of the amputated part, lack of awareness on amputated part preservation and transportation by the public, poor referral systems, lack of equipment such as operating microscopes, and lack of microsurgical experts among others (4). Despite microsurgical penile reimplantation being an uncommon procedure, it is currently the ideal treatment option for penile amputation because it provides better sensory and erectile function than non-microsurgical techniques (2,4,5).

Case Report 

A 17-year-old male was referred to our facility after assault by people known to him with machetes in what was reported as a family feud. During the assault, he had his penis amputated by a machete and also sustained laceration to his left ear and the left half of the parietal scalp. The amputated part was stored directly in ice, and pressure was applied on the stump with a piece of cloth. He was rushed to the hospital, which was 2 hours away. At the hospital, the patient arrived with reduced level of consciousness. He was given tetanus toxoid, analgesics, and antibiotic. A unit of blood was transfused, and his scalp and ear lacerations were sutured. Hemostasis of the stump was achieved by clamping the vessels using artery forceps (Figure 1). The stump was wrapped in moist gauze, stored in a plastic bag that was stored in a cooler box with ice packs (Figure 2). After the stabilization, he was referred to our facility, which was 2 hours 15 minutes away. He presented 8 hours after the assault to our facility. He had no pre-existing medical condition and was neither a smoker nor user of any health risk substance. The patient was stabilized and prepared for the emergency procedure. The parent was counselled on the replantation procedure, and they fully consented. The patient was then taken to the theater 2 hours after arrival and 10 hours post-amputation.

 

Patient was placed under general anesthesia, and a suprapubic cystostomy was performed by the urology team (Figure 1). The stump was then exposed, revealing a clean cut at the proximal penile shaft (Figure 1).

Click to view figure 1Figure 1;The stump

Click to view figure 2: Figure 2;The amputated part.

The stump and amputated part were both prepared by cleaning them with saline using a syringe and gauze, then the edges were freshened to remove any damaged tissue and debris. The structures identified were the urethra,  corpora  carvenosa  and  spongiosumthe