Successful penile replantation
A 31-year-old male was assaulted with scissors by his wife because of his betrayal when he was sleeping. His penile glans was almost completely cutoff. There was massive bleeding after penile amputation. He had been sent to two medical center, but finally he was transferred to our urological center.
Warm ischemia had lasted 6 hours and surgical preparation had lasted 1 hour, total warm ischemia time was 7 hours since amputation. Then, emergency surgery was performed immediately under general anesthesia.
The distal urethra and the bilateral corpus cavernosum were completely severed (Fig. 1A), but the testicles and scrotum remained intact. The amputated glans had a skin flap connected with penis (Fig. 1B). Then, an end-to-end anastomosis of the urethra and corpus cavernosum was performed using interrupted 4-0 absorbable suture. Replantation was completed by closing the fascial layers and skin (Fig. 1C). After surgery, he was anticoagulated with intravenous heparin and transferred to general ward.
The obvious edema of amputated penis was observed 12 hours after surgery because of venous congestion (Fig. 1D). They used a thick needle from 20ml injector (Fig. 1D) to pierce the skin of edema area to let black blood flow out (Fig. 1D). At the second day, they repeated vein bloodletting therapy (Fig. 1E).
The patient was discharged 2 weeks after operation (Fig. 1F). Nineteen days after surgery, the black scab was removed and the pink granulation tissue was showed up (Fig. 1G). The catheter was removed one month after surgery (Fig. 1H).
Three months later, the patient reported that he could complete sexual intercourse with effective erectile function, and had good urinary pattern without urethral stricture, intact glans and adequate esthetic acceptance (Fig. 2). The glans had obvious sense of touch and mild pain sensation.
Corresponding author. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University