Successful replantation of an amputated penis

In December 2012, a 35-year-old Berber man, without any past medical history, presented to our Emergency Department with incomplete amputation of his penis after being assaulted by an unknown actor who cut off his penis using a shaving blade 3cm distal from the mons pubis. A physical examination did not show any other remarkable finding. There was a clear cut through his cavernosal bodies with diffuse bleeding from the dorsal vessels (Figure 1)

Figure 1. Incomplete amputation of penis.

. His scrotum and testicles were found to be intact. After thorough ablution with Ringer’s lactate solution and an antitetanic injection he was admitted to the Operation Room. As he had lost blood before his admission, he was transfused with two units of red blood cells during reimplantation. He was placed under general anesthesia. A rubber band was placed, as a tourniquet, around the proximal end under his pubis for bleeding control. A 16Fr. silicone catheter was inserted transurethrally through the distal amputated part followed by the anastomosis of his urethra and the cavernosal bodies. His urethra was repaired by end-to-end anastomosis using interrupted 4/0 synthetic absorbable sutures. The tunica albuginea of corporal bodies was repaired circumferentially with 3/0 vicryl. His superficial deep dorsal veins as well as his deep penile arteries were not repaired. As a last step his Buck’s fascia was closed with 3/0 vicryl and the skin with 3/0 nylon (Figure 2).

Figure 2.
The replantated penis showed considerable edema of the skin, of the penile shaft and the prepuce.

Total ischemia time was about 6 hours. The Foley catheter was removed after 4 weeks postoperatively with good urine flow. On follow-up examination, 5 weeks later, no necrosis was noticed on his skin; there was a normal-appearing penis (Figure 3) without difficulty in voiding and good sensation. He reported the restoration of his penile erection and ejaculation during sexual intercourse.

Figure 3. A normal-appearing penis.