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Paraphimosis it is an emergency which represent the inability to retract the penis into the preputial sheets. Paraphimosis may be congenital resulting from preputial hypoplasia and small preputial orifice or could be acquired resulting from constriction of preputial orifice with hair, trauma, masturbation or coitus with persistent glans engorgement. The treatment goal is to reduce the dimensions of the glans, allowing it to be replaced into the sheets, before any severe damage appear. Poor management can lead to penile amputation due to ischemia, gangrenous necrosis, self-trauma with urethral lesions which impair urination. The study presents a severe case of paraphimosis, due to self-masturbation and preputial hair rings, with extensive necrotic lesions due to ischemia and self-mutilation lesions of a 2,8 years old Mioritic Shepard intact male. The severity of the vascular changes with irreversible damage of the penis and the extent of the self-mutilation injuries, required the scrotal urethrostomy and the amputation of the penis, with satisfactory results even if minor surgical complications were observed in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Background: Swelling of the perineal region in male dogs is most commonly caused by a perineal hernia. Clinical signs associated with perineal hernia are constipation, tenesmus or stranguria. This case report documents a rare cause of perineal swelling created by the growth of a malignant tumour leading to urethral obstruction and subsequent stranguria. Case presentation: An 11-year-old neutered male German Shepherd was presented for swelling in the perineal region and stranguria for three days. Complete blood count and serum biochemistry were unremarkable. Ultrasound revealed a heterogeneous mass in the perineal region. Retrograde urethrography showed a severe narrowing of the urethra caudal to the pelvis. A fine-needle aspirate of the mass was highly suspicious for liposarcoma. Staging was performed by computed tomography (CT) of the thorax and abdomen. Total penile amputation in combination with pubic-ischial pelvic osteotomy, transposition of the remaining urethra through the inguinal canal, V-Y-plasty cranial to the prepuce and preputial urethrostomy were performed to remove the tumour. Histopathology confirmed a well-differentiated liposarcoma with complete histological margins. Six months after the surgery the dog was doing well and there were no signs indicating local tumour recurrence. Conclusions: Wide surgical excision is generally recommended for soft tissue sarcomas, however this is sometimes not feasible for large tumours. In the case reported here, tumour resection was achieved by a combination of several surgical techniques with a good clinical outcome. [ABSTRACT FROM AUTHOR]

Penile amputation is a rare condition that requires immediate intervention to provide sexual and voiding function. The most common cause is self-mutilation during psychotic attacks and known as Klingsor syndrome. In this study, we present a case of proximal-level total penile amputation of a schizophrenic patient with a review of the literature focusing on long-term results. In this case, the dorsal penile arteries, veins, and nerves were repaired using the standard microsurgical method. There was no perfusion problem in the glans penis or distal penile shaft in the early postoperative period. Skin necrosis developed in the penoscrotal region, which is known to be perfused from the external pudendal artery system. Necrosis was reconstructed with a local flap after debridement. In the long term, no problems that could lead to voiding dysfunction, such as fistula or stricture in the urethra, were observed. At the end of the fourth year, the patient was able to achieve or maintain an erection that would provide sufficient penetration. This study demonstrates the long-term success of microsurgery in a penile amputation case with quantitative Doppler ultrasonography and urodynamic testing results. To avoid skin necrosis problems in pubic-level amputations, we suggest to repair the external pudendal system. [ABSTRACT FROM AUTHOR]

Objectives: To describe a novel technique for partial anatomic penile amputation using a thoracoabdominal stapler in dogs and to report any associated short‐term peri‐operative complications and clinical outcomes associated with the procedure. Materials and methods: Medical records from a tertiary referral hospital were reviewed for dogs undergoing penile amputation and scrotal urethrostomy between October 2007 and December 2019. Data collected included patient signalment, clinical signs on presentation, indication for penile amputation, surgical technique, duration of surgery, post‐operative complications, and short‐term outcome. Results: Nine dogs were included in the study. Indications for surgery were for treatment of chronic paraphimosis and priapism (n = 3), recurrent urethral prolapse (n = 2), balanoposthitis (n = 1), masses arising from the penis, prepuce, and/or urethra (n = 2), and penile trauma (n = 1). All dogs underwent a scrotal urethrostomy followed by a partial penile amputation with a thoracoabdominal stapler. All dogs suffered mild post‐operative haemorrhage from the urethrostomy stoma. On recovery from general anaesthesia, 2/9 dogs were painful and another 2/9 dogs were dysphoric. Two dogs experienced incisional complications with mild swelling around the urethrostomy stoma. One dog experienced an infection of the penile amputation site 21 days after surgery. The short‐term outcomes for this procedure were excellent in 8/9 dogs. These outcomes were based on owner assessment of comfort and monitoring throughout the recovery period, manual palpation of the surgical site at the time re‐evaluation, and surgeon visualization of successful voluntary urination 14–35 days after surgery. Clinical significance: Use of a thoracoabdominal stapler is effective in achieving partial anatomic penile amputation in dogs. [ABSTRACT FROM AUTHOR]

Amputation of the penis is a rare and devastating injury. The etiologies vary from accidental, self-inflicted to attacks due to sexual jealousy and revenge. In the present era of microvascular surgery, replantation is the standard care. However, replantation of the penis comes with its own set of difficulties and complications. Knowledge of the anatomy and prior knowledge of the possible complications makes the surgeon aware of the course of events after a replantation. It helps in devising strategies to overcome these challenges methodically. We present a case of penile replant with the complications that we encountered, and the measures are taken to counter them on our way to a successful outcome. [ABSTRACT FROM AUTHOR]

Invasion of the tunica albuginea (TA) and/or urethra are key factors in determining the feasibility of organ-preserving surgery in penile cancer (PC). Magnetic resonance imaging (MRI) appeared to be a promising technique for preoperative local staging. We performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of MRI in preoperative local staging of primary PC. An SR up to May 2021 was performed according to the PRISMA statement. The diagnostic performance of MRI was evaluated according to TA invasion, urethra invasion, and pT-stage ≥ 2. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed. Overall, seven qualified studies were deemed suitable. Diagnostic performance of MRI showed an accuracy of 0.89 for TA invasion (sensitivity 0.78, PPV 0.79, specificity 0.91, and NPV 0.90); an accuracy of 0.88 for urethra invasion (sensitivity 0.65, PPV 0.46, specificity 0.86, and NPV 0.93); an accuracy of 0.90 for pT ≥ 2 (sensitivity 0.86, PPV 0.84, specificity 0.70, and NPV 0.73).Currently available evidence indicates that MRI might be a one-stop shop for local staging of primary PC and play a central role with regard to conservative surgical management. [ABSTRACT FROM AUTHOR]

Objective: There are very few studies reporting the techniques utilized in penile replantation. Of those in literature, many agree that the use of microvascular technique results in better outcomes. The most common complications are skin necrosis and venous congestion, which are even higher in replants without arterial supply. Methods: This study describes a case of self-inflicted penile amputation treated with microsurgical replantation and managed postoperatively with hyperbaric oxygen therapy and Cialis (tadalafil), and SPY angiography. The penile replant had extensive skin necrosis, which prevented a sufficient clinical evaluation of the replanted penis. Serial SPY angiography was performed to assess tissue viability, following hyperbaric oxygen therapy and Cialis treatment. Results: SPY angiography was critical to the decision making of the operating team in the management of this case of penile replantation. Conclusions: The use of SPY angiography prevented the patient from undergoing revision amputation and allowed for a safe and successful penile replantation. [ABSTRACT FROM AUTHOR]

Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on-site expertise in genitourethral surgery. A series of consensus statements have been developed by an expert consensus committee comprising members of the British Association of Urological Surgeons (BAUS) Section of Andrology and Genitourethral Surgery together with experts from urology units throughout the UK. Penile amputation is a rare genital emergency, which requires prompt intervention and microsurgical reconstruction. The consensus statements will outline the management of these cases for non-specialist units, as well as recommendations for reconstruction for specialists. [ABSTRACT FROM AUTHOR]

The aim of our review was to collect and analyze all the available literature about surgical treatment penile carcinoma to understand the real implication of this kind of surgery on patients' quality of life (QoL). A systematic literature search (English or French written literature) was conducted in electronic database MEDLINE, using the key search terms "Penectomy AND quality of life." Studies from 1994 to 2017 concerning the implications of surgical treatment for penile carcinoma were collected and analyzed. A manual search of reference lists of included studies and review articles was successively performed. All references of the retrieved studies were also reviewed to avoid missing relevant publications. Ten articles were included in the systematic review. The studies were settled in Denmark, Brazil, Norway, Italy, Netherlands, Poland, China, and the United States. The enrolled patients ranged from 4 to 155 and had a mean age at the interview of 50.5'67 years old. Patients underwent several types of surgery: glansectomy, partial or total amputation, emasculation. Sexual function represented the most important element negatively influenced by the surgical treatment especially for patients who underwent more invasive treatments leading to anxiety or depression. Most patients didn't report significant alterations of their QoL and reported satisfying relationships with their partners because of the support received from them. The age was one of the most important aspects that influenced the QoL. In conclusion, in contrast to what expected our review demonstrated an excellent overall QoL after surgery for penile carcinoma. [ABSTRACT FROM AUTHOR]

Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self‑mutilation. Eighty‑seven percent of the self‑mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health‑care team. A 25‑year‑old male patient presented to our emergency department with self‑inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner’s warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases. [ABSTRACT FROM AUTHOR]

Background: Circumcision is a common minor surgical procedure and it is performed to a varying extent across countries and religions. Despite being a minor surgical procedure, major complications may result from it. In Ghana, although commonly practiced, circumcision-related injuries have not been well documented. This study is to describe the scope of circumcision-related injuries seen at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Methods: The study was conducted at the Urology Unit of the Komfo Anokye Teaching Hospital in Kumasi. Consecutive cases of circumcision-related injuries seen at the unit over an 18 month period were identified and included in the study. Data was collected using a structured questionnaire. Data was entered and analysed using SPSS version 16. Charts and tables were generated using Microsoft Excel. Results: A total of 72 cases of circumcision-related injuries were recorded during the 18 month period. Urethrocutaneous fistula was the commonest injury recorded, accounting for 77.8 % of cases. Other injuries recorded were glans amputations (6.9 %); iatrogenic hypospadias (5.6 %), and epidermal inclusion cysts (2.8 %). The majority of children were circumcised in health facilities (75 %) and nurses were the leading providers (77.8 %). The majority of circumcisions were conducted in the neonatal period (94.7 %). Conclusion: Circumcision-related injuries commonly occurred in the neonatal period. Most of the injuries happened in health facilities. The most common injury recorded was urethrocutaneous fistula but the most tragic was penile amputation. There is the need for education and training of providers to minimise circumcision-related injuries in Ghana. [ABSTRACT FROM AUTHOR]

Schizophtrenia is a chronic mental disorder that is characterized by perceptual, thinking, cognitive, and behavioural disturbances. One of the important symptoms of schizophrenia is auditory hallucinations. In this case report, we discussed a 31-year-old Rohigya refugee man who had his penis totally amputated. The auditory hallucinations instructed him to do so. He was rushed to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for the immediate surgical treatment. After his condition was stabilized, he was admitted to the psychiatric ward for further observation and medical treatment. Some issues related to psychosocial, economic and politic were discussed which made this case unique. Patient was treated with medication sulpride and was referred to the Urology Surgeon for further management. [ABSTRACT FROM AUTHOR]

Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the "standard" method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V. [ABSTRACT FROM AUTHOR]

CASE REPORTS Records of five dogs that were presented with fracture of the os penis secondary to trauma were reviewed. All dogs presented with stranguria and dysuria, and the urethra was unable to be catheterised in three of them. Other clinical abnormalities noted were one dog each with haematuria, crepitus and mobility on penile palpation, thickened fracture site on palpation and wounds close to the prepuce with urine leakage. Plain radiography confirmed the fracture in all dogs. Contrast retrograde urethrography showed urethral narrowing in two dogs and contrast extravasation through the preputial wound in one dog. Treatment included a scrotal urethrostomy (3 cases), placement of an indwelling catheter (2 cases) and a partial penile amputation (1 case). Complications included haemorrhage in all dogs and urethral obstruction in one dog, which was managed successfully with a scrotal urethrostomy. CONCLUSION All dogs had a favourable outcome after follow-up of almost 18 months. [ABSTRACT FROM AUTHOR]

Penile amputation is rare and hence the paucity of experience and publication. We present our case of self-inflicted penile amputation, which was successfully managed with microsurgical replantation, with relevant literature review. [ABSTRACT FROM AUTHOR]

An eight year old gelding with a history of inability to retract his penis was presented to the clinic. Physical examination revealed granulomatous lesions on the penis. Local and systemic treatment for two weeks did not show any improvement. Animal was found negative for habronemiasis. Histological examination of the paraphimosed penis was indicative of pyogranuloma. As remedial measure amputation of the penis and penile urethrostomy were carried out. Animal recovered uneventfully after about a week and was sent back to the track. [ABSTRACT FROM AUTHOR]

Complete transection of both corpora cavernosa and the urethra is a very rare condition in urology. We report the case of a 59-year-old man with complete transection of the corpora cavernosa and the urethra during a laparoscopic repair of a recurrent inguinal hernia. [ABSTRACT FROM AUTHOR]

Condom catheter (CC) serve as an non-invasive external urinary catheter drainage. These are specially used in bedridden patients, patients with incontinence and also in patients with reduced mobility. However CC too are not without complications. Skin irritation, contact dermatitis, penile skin inflammation, urethral fistulaes, gangrene have been reported in literature due to condom catheter. We present a case of total penile necrosis secondary to condom catheter calling it as Condom Penile Necrosis. Our case as an eye-opener highlights the importance of proper CC care. [ABSTRACT FROM AUTHOR]

Penile amputation is a catastrophe and the goal should be to restore adequate mass, sensation and functionality of penis considering penile prosthesis where necessary. A case of a 25 year soldier who had penile amputation due to improvised explosive device blast injury is reported. [ABSTRACT FROM AUTHOR]

Penile hair strangulation is secondary to a hair tourniquet effect. Albeit a rare presentation in pediatric emergency units, penile hair strangulation must be cautiously noted in any penile pain and edema, to avoid inevitable damage to external genitalia, including penile necrosis, urethrocutaneous fistula, and even amputation. [ABSTRACT FROM AUTHOR]

Circumcision is one of the oldest and most commonly performed surgical procedures. Unfortunately, various complications may occur during circumcision, ranging from trivial to tragic such as penile amputation which is a serious complication and a challenging injury to treat. We describe two cases of non-microsurgical successful reattachment of a distal penile glans which were amputated during circumcision. In the first case, a 5-year-old child underwent circumcision by an urologist under local anesthesia. In the second one, a 3-year-old child underwent circumcision by a general practitioner who used to make circumcision. In this article, the literature is reviewed; results and potential complications of this surgery are also discussed. Glans sensation was present, early morning erection was maintained, and there was an erectile response during penile manipulation in both cases. Although circumcision is not technically difficult, it should be taken seriously. The use of microsurgical reattachment is not always possible, especially in pediatric cases; it also requires special equipment and training. [ABSTRACT FROM AUTHOR]

Incidence of penile carcinoma is decreasing worldwide. Nevertheless, the incidence of penile cancer is still significant in various tropical countries, and it often presents in advanced stage. We report two unique cases of penile auto-amputation due to advanced cancer and review relevant literature. Both the patients presented with ulcerative lesion replacing penile base following automatic sloughing of the whole penis and voiding dysfunction. In addition, the first patient had metastatic inguinal lymph nodes. Supra-pubic urinary diversion was the initial management in both the patients. The first patient was treated with combined chemo-radiation, but he succumbed to death following two cycles of chemotherapy. The second patient was successfully treated with total penectomy and perineal urethrostomy. He recovered well but was lost to follow-up. [ABSTRACT FROM AUTHOR]

Self-mutilation of genitalia is an extremely rare entity, usually found in psychotic patients. Klingsor syndrome is a condition in which such an act is based upon religious delusions. The extent of genital mutilation can vary from superficial cuts to partial or total amputation of penis to total emasculation. The management of these patients is challenging. The aim of the treatment is restoration of the genital functionality. Microvascular reanastomosis of the phallus is ideal but it is often not possible due to the delay in seeking medical attention, non viability of the excised phallus or lack of surgical expertise. Hence, it is not unusual for these patients to end up with complete loss of the phallus and a perineal urethrostomy. We describe a patient with Klingsor syndrome who presented to us with near total penile amputation. The excised phallus was not viable and could not be used. The patient was managed with surgical reconstruction of the penile stump which was covered with locoregional flaps. The case highlights that a functional penile reconstruction is possible in such patients even when microvascular reanastomosis is not feasible. This technique should be attempted before embarking upon perineal urethrostomy. [ABSTRACT FROM AUTHOR]

We are reporting a newborn male who had injury of the penis probably due to rat bite. The baby was brought to the hospital within 3 h of the injury. The urethra was completely transected. Macroscopic repair was performed. The patient had an uneventful recovery and was discharged after 2 weeks. The patient is doing well 3 months after the operation. [ABSTRACT FROM AUTHOR]

We report a case of 20-year-old farmer with penile amputation and emasculation secondary to crushing injury inflicted by agricultural machinery. His entire penis, scrotum and both the testis had been avulsed after falling onto a rotating axel wheel of an electronically driven thrashing machine. After resuscitation the wound was thoroughly washed with saline, hemostasis achieved and a perineal urethrostomy was made from the remnant urethra. [ABSTRACT FROM AUTHOR]

Traumatic amputation of the penis is a rare condition. The paper presents a 22-year old man who suffered a complete penile amputation in a result of an unfortunate accident. Microsurgical replantation of the penis was performed in the case with a complete return of sensation, sexual function and physiologic miction. Microsurgical replantation is the treatment of choice for this injury. [ABSTRACT FROM AUTHOR]