V7-08: MULTIDISCIPLINARY RECONSTRUCTION OF AN AMPUTATED PENIS
VideoIntroductions and Objectives
Albeit rare, penile replantation following amputation has been reported. We present the successful repair of an amputated penis using a multi-disciplinary approach involving urology, plastic surgery, and environmental medicine.
A 22 year old man with a history of depression presented within 4 hours of penile self-amputation with a kitchen knife after experiencing auditory hallucinations. He underwent an eight hour procedure involving penile replantation, suprapubic tube insertion, and Foley placement by urology and neurovascular reconstruction with skin closure by plastic surgery. Two deep dorsal veins were reconstructed with forearm vein grafts, and three dorsal nerves were repaired; no arteries were identified. Initial post-operative treatment included local wound care, daily tadalafil, and 20 treatments of hyperbaric oxygen. SPY Elite®, a fluorescence imaging system (Novadaq, Bonita Springs, FL), was used to guide penile skin debridement and monitor post-operative tissue perfusion. The Foley catheter was removed one week after surgery. At three weeks, the patient underwent further skin debridement and cystoscopy. The urethral anastomosis appeared well healed and the suprapubic catheter was removed. At four weeks, the patient underwent skin grafting and was transferred to the psychiatric service for continued care.
At 4 months of follow-up the patient had developed meatal stenosis, which responded to intermittent self-dilation. A retrograde urethrogram demonstrated an intact urethra. The repair resulted in partial sensation to the shaft and glans, and the patient is currently potent and able to ejaculate with manual stimulation. At 7 months follow-up, the patient continues to have erections and no recurrence of meatal stenosis.
This rare case illustrates the benefit of a multidisciplinary approach and the potential role of SPY Elite® and hyperbaric oxygen in penile replantation.