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Successful Replantation of Amputated Penile Shaft following Industrial Injury

Article  in  International Journal of Occupational and Environmental Medicine · October 2010

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198 www.theijoem.com Vol 1 Number 4; October, 2010

Case Report

Successful Replantation of Amputated Penile Shaft following Industrial Injury

M Salehipour, A Ariafar

Department of Urol-ogy, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence toMehdi Salehipour, MD, Department of Urol-ogy, Nemazi Hospital, Shiraz, IranE-mail: salehipour@sums.ac.ir

Abstract

Penile amputation is an uncommon urological emergency. Although rare, traumatic amputa-tion of penis is a challenging injury to treat. However, modern microsurgical reconstruction techniques have improved success rate of penile replantation and become the procedure of choice for managing these patients. Herein, we report on a case of penile amputation follow-ing an industrial accident.

Keywords: Amputation, traumatic; Safety, occupational; Replantation; Industrial acci-dent; Occupational accident

Introduction

Penile amputation is a rare type of genitourinary tract injury that nega-tively affects victim’s quality of life.

The majority of these cases occur as a re-sult of self-mutilation in psychiatric pa-tients as a response to hallucinatory com-mand or else as a result of violent assault.1 It may also occur secondary to industrial work accident or war injury.2 Penile am-putation has also been reported as a rare complication of circumcision.3,4 Herein, we report on a case of penile amputation following an industrial accident.

Case Report

A 26-year-old man presented to the emer-gency room with bleeding from his penis. He was injured with high speed fragments of the disk of an electrical air angle stone grinder suddenly broken when he was working with. On physical examination, the penis was almost completely ampu-tated from the mid-shaft with complete

dissection of the urethra and both corpora cavernosa (Fig 1).

During surgical replantation of the shaft, urethral ends were spatulated and anastomosis was created with continu-ous 4-0 poly-diaxanone (PDS) sutures on a 16-F silicon catheter. The corpora caver-nosa were repaired with interrupted 3-0 PDS sutures. The deep dorsal arteries and vein were anastomosed with 8-0 prolene sutures using a 2.5× magnified loop (Fig 2). The skin was closed with 4-0 chromic sutures.

In the hospital course, the patient re-ceived systemic antibiotics (cephalothin and amikacin). The post-operative course was uneventful and the patient was dis-charged one week after operation with oral antibiotics and anti-androgen drugs. The urethral catheter was removed after four weeks and the patient voided without difficulty.

On a two-year follow-up, the patient had no voiding problems and no erectile dysfunction though he had a mild left lat-eral chordee and penile skin numbness.

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c a s e r e p o r t

Discussion

In 1926, Ehrich reported the first case of penile replantation in a patient who had amputated his penis by a radial saw.5 Am-putation of the penis is usually an act of self-emasculation done by acutely ill psy-chotic patients. Greilsheimer and Groves showed that 87% of patients who ampu-tate or mutilate their genitalia are believed or shown to be psychotic at the time of the accident and that 51% of whom are in a de-compensated schizophrenic state. Another group of these patients has severe charac-ter disorders or gender identity problems.1

The majority of penile injuries are due to industrial machinery, motor vehicle accidents and burn.2,6 Traumatic penile amputations resulting from accidents are rare. Traumatic amputation resulting from felonious assault is also rare. A large series of assaults have been reported in Thailand where an epidemic of approxi-mately 100 cases of penile amputation oc-curred during the 1970s when numerous women amputated their husband’s genita-lia after marital indiscretion.7

War-related penile amputations may also occur—5% of urologic injuries during the Vietnam war were penile.8

Decreased ischemic time of the ampu-tated penis significantly affects the out-come of surgery. Hypothermia has been shown to prolong the ischemia time and tissue survival. Therefore, the amputated portion should be placed on a saline-soaked gauze and put into a sterile or clean plastic bag. The bag is then immersed in iced slush.9

Penile amputation is a catastrophic event during life of a man. Therefore, all attempts should be made for saving the penis. The goal of surgery is both cosmetic and functional to provide sufficient penile length with normal erection and a patent urethra for comfortable voiding.

In summary, microsurgical replanta-

Figure 1: Photograph shows amputated corpora cavernosa and urethra. The silicon catheter is inserted in the urethra. The injured dorsal penile artery is clamped.

Figure 2: Amputated penis after reconstruction of urethra and corpora cavernosa (arrow head) and dorsal penile artery (thin arrow). Thick arrow shows deep dorsal vein before reconstruction.

M. Salehipour, A. Ariafar

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c a s e r e p o r t

tion is the treatment of choice for penile amputation. If microsurgery is not feasi-ble, macroscopic replantation should still be offered.

References

1. Greilsheimer H, Groves JE. Male genital self-mutila-tion. Arch Gen Psychiatry 1979;36(4):441-6.

2. Fuller A, Bolt J, Carney B. Successful microsurgical penile replantation after a workplace injury. Urol Int 2007;78(1):10-2.

3. Aydin A, Aslan A, Tuncer S. Penile amputation due to circumcision and replantation. Plast Reconstr Surg 2002;110(2):707-8.

4. Park JK, Min JK, Kim HJ. Reimplantation of an

amputated penis in prepubertal boys. J Urol 2001;165(2):586-7.

5. Ehrich WS. Two Unusual penile injuries. J Urol 1929;21:239-241.

6. Perovic SV, Djinovic RP, Bumbasirevic MZ, et al. Severe penile injuries: a problem of severity and reconstruction. BJU Int 2009;104(5):676-87.

7. Bhanganada K, Chayavatana T, Pongnumkul C, et al. Surgical management of an epidemic of penile am-putations in Siam. Am J Surg 1983;146(3):376-82.

8. Jezior JR, Brady JD, Schlossberg SM. Manage-ment of penile amputation injuries. World J Surg 2001;25(12):1602-9.

9. Jordan GH. Initial management and reconstruc-tion of male genital amputation injuries. Traumat Reconstr Urol 1996;57:673-681.

Replantation of Amputated Penile Shaft

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