Microscopic replantation of completely amputated penis and testes: a case report and literature review

• Published in: International urology and nephrology 2020-07, Vol.52 (7), p.1271-1277
• Main Authors: Liu, Xu-Dong, Li, Yan-Feng, Wang, Qi, Zhang, Yong, Luo, Yong, Zhou, Bo, Huang, Zao-Ming, Nie, Zhi-Lin, Li, Ke, Feng, Qing-Xing, Jiang, Jun
• Format: Article
• Language: English
• Subjects: Adult; Amputation; Amputation, Traumatic - surgery; Analgesia; Anastomosis; Atrophy; Case reports; Hormone replacement therapy; Humans; Hyperbaric oxygen therapy; Literature reviews; Male; Medicine; Medicine & Public Health; Microsurgery; Nephrology; Pain perception; Patients; Penis; Penis - injuries; Penis - surgery; Recovery of function; Replantation - methods; Surgery; Testes; Testis - injuries; Testis - surgery; Testosterone; Urology; Urology - Original Paper
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-020-02407-z

Objective The aim of this study was to summarize in a literature review our treatment experience involving microscopic replantation in a rare case of a completely amputated penis and testes. Patient and methods The penis and testes were completely amputated due to self-mutilation. The 26-year-old patient immediately underwent microscopic replantation of the penis and testes after pre-operative preparation. Potent anti-infectives and anti-depressives, and microcirculation-improving hyperbaric oxygen therapy were utilized after surgery. Results The time between the amputation and surgery was about 10 h. The patient was followed for 12 months post-surgery. The replanted penis recovered and the patient could urinate normally in the standing position with a maximal urinary flow rate of 20 ml/s. The testes also survived, but their size showed obvious atrophy. The serum testosterone level at 2 months after the operation was 120 ng/dL (normal reference range: 175–781 ng/dL). Erectile function gradually recovered after androgen replacement therapy. Conclusion Complete amputation of the penis and testis is very rare. Efforts should be made to perform the replantation surgery as soon as possible. Microscopic surgical techniques for elaborate vascular and neural anastomosis constitute the basis for a successful replantation. Post-operative comprehensive treatment such as strong anti-infection, analgesia, anti-depression, improvement of microcirculation, and hyperbaric oxygen is crucial for the survival and functional recovery of replanted organs.