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Introduction: Total penile amputation following circumcision is a rare complication. This case highlights the challenges associated with managing such a catastrophic injury in a resource-limited setting. Case presentation: A 46-day-old male was brought to our hospital with a five-day history of difficulty voiding, irritability, and bleeding from a circumcision done two weeks earlier by a traditional healer under suboptimal conditions. The mother reported a proper initial recovery but stated that the penis became followed by penile discolored and detached five days prior to presentation. Despite the severe injury, the patient had no fever or systemic symptoms. On admission, he was afebrile and pale. The perineal exam revealed a total penile amputation, and a nasogastric tube placed in the urethra at the referring hospital. Blood tests showed anemia (hemoglobin 8.2 g/dL) but normal renal function. The urinalysis was normal. An abdominal ultrasound (US) ruled out hydronephrosis. The patient received a blood transfusion, intravenous ceftriaxone, and pain medications. He was taken to the operating room for an exam under anesthesia. We did a debridement of the necrotic tissue and reconstructed the urethral opening with skin flaps. We left an 8 French nasogastric tube in the urethra. The postoperative recovery was uneventful. At three months of follow up, he has healed properly and has a patent neourethral meatus. Conclusion: Reconstruction of the urethral opening using locally mobilized skin flaps and urinary drainage via catheter placement can achieve satisfactory outcomes in infants with total penile amputation when advanced surgical resources are unavailable.

Circumcision is among the most commonly performed surgical procedures in boys. In Morocco, this practice is often carried out by traditional practitioners, exposing patients to potentially catastrophic complications that are challenging to manage. We report the case of a 2-year-old boy who underwent ritual circumcision complicated by total penile amputation, with loss of the amputated stump. A meatoplasty was performed, and the postoperative course was uneventful. This case underscores the importance of recognizing circumcision as a surgical procedure that should not be trivialized. Furthermore, it highlights the necessity of implementing training programs for traditional practitioners to promote safe circumcision practices.

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]

Abstract 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.

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]

Objective To improve the early management of penile amputation injury by analyzing and summarizing our microreplantation experience of 4 cases of complete penile amputation. Methods Clinical data of 4 patients with complete penile amputation admitted to our hospital from March 2018 to October 2022 were collected, and their related clinical features, microsurgical procedures, post-operative treatment and follow-up outcomes were retrospectively analyzed. Results Meticulous anatomical microreplantation was successfully performed on all the 4 patients. Two of them received successfully bilateral penile dorsal arteries anastomosis, and the other two got only one dorsal artery anastomosis. All patients completed anastomosis of deep dorsal penile vein, and 3 of them had superficial dorsal vein anastomosis. Anastomosis of 4~6 dorsal nerves on both sides of the back of the penis were completed in all the patients. The operation time ranged from 6.5 to 7.5 h, with an average of 6.9 h. The warm ischemia period was 1~4 h, averagely 1.9 h. During the follow-up, 3 cases obtained successful penis replantation, although 2 of them had partial necrosis of foreskin, which healed naturally after 2~3 months. These 3 patients had normal urinations after operation, and had an erectile hardness score of 3~4 in 3~6 months after operation, with satisfactory self-reported recoveries. Conclusion For the patients with short warm ischemia period after complete penile amputation, microreplantation should be carried out as soon as possible in order to obtain satisfactory appearance and functional recovery of the penis.

Penile Hair Tourniquet Syndrome, a subtype of Penile Tourniquet Syndrome, is a rare condition and a pediatric surgical emergency seen in infants whereby a constricting hair coil strangulates the penis most often at the coronal sulcus, leading to edema, ischemia and necrosis, If untreated, it can potentially lead to development of a urethrocutaneous fistula or even urethral transection and penile amputation. Therefore, a well-timed intervention can prevent complications and lifelong unhappiness. Herein, we present a case of an 11-month-old boy who presented with near total amputation of the glans and underwent two-staged repair with a satisfactory outcome.

Total penile amputation following circumcision is a rare complication. This case highlights the challenges associated with managing such a catastrophic injury in a resource-limited setting. A 46-day-old male was brought to our hospital with a five-day history of difficulty voiding, irritability, and bleeding from a circumcision done two weeks earlier by a traditional healer under suboptimal conditions. The mother reported a proper initial recovery but stated that the penis became discolored and detached five days prior to presentation. Despite the severe injury, the patient had no fever or systemic symptoms. On admission, he was afebrile and pale. The perineal exam revealed a total penile amputation, and a nasogastric tube placed in the urethra at the referring hospital. Blood tests showed anemia (hemoglobin 8.2 g/dL) but normal renal function. The urinalysis was normal. An abdominal ultrasound (US) ruled out hydronephrosis. The patient received a blood transfusion, intravenous ceftriaxone, and pain medications. He was taken to the operating room for an exam under anesthesia. We did a debridement of the necrotic tissue and reconstructed the urethral opening with skin flaps. We left an 8 French nasogastric tube in the urethra. The postoperative recovery was uneventful. At three months of follow up, he has healed properly and has a patent neourethral meatus. Reconstruction of the urethral opening using locally mobilized skin flaps and urinary drainage via catheter placement can achieve satisfactory outcomes in infants with total penile amputation when advanced surgical resources are unavailable. [ABSTRACT FROM AUTHOR]

Abstract 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.

Intentional self-amputation of the penis is rarely encountered and usually occurs in the context of an underlying psychiatric illness. We report the case of a 42-year-old male who intentionally amputated his penis, both testicles, and a large portion of the scrotum en bloc using garden shears. Microscopic and macroscopic replantation of the penis was undertaken, resulting in restoration of normal urinary function and moderate erectile function.

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]

This study aims to report the oncological, surgical and functional outcomes in 15 patients with locally advanced penile cancer who underwent total penile amputation with perineal urethrostomy (PU). A single-center retrospective analysis was conducted from January 2018 to September 2023. Outcomes included postoperative complications, cancer-specific survival (CSS), and overall survival (OS). Functional outcomes and pre and postoperative quality of life (QoL) were assessed by the International Prostate Symptom Score (IPSS) validated questionnaire. The median follow-up period was 10 months (SD±7). The median age of patients was 73 years (IQR 63-77), with a median Body Mass Index (BMI) of 28.1 kg/m 2 (IQR 25.0-29.9). Risk factors included lack of circumcision (60.0%), history of lichen sclerosus (33.3%), and obesity (26.7%). The primary symptom reported was pain (67.0%). Total penectomy with PU was the initial surgery in 40.0% of cases; the rest underwent surgery after recurrence after penile organ-sparing surgery or partial penile amputation. Median operative time was 170 minutes (IQR 142.5-211.5), and the median hospital stay was 6 days (IQR 5-10). No local recurrence occurred during follow-up. The overall complication rate was 33.4%, with one patient (6.7%) requiring surgical revision (Clavien ≥ III). CSS was 80.0% with a median time to death of 6 months (IQR 3-13), and OS was 60.0%. Urinary symptoms and QoL significantly improved postoperatively (P = 0.0005 and P = 0.0012, respectively). Total penile amputation with PU is a safe procedure with acceptable complications and favorable functional outcomes., Competing Interests: None., (AJTR Copyright © 2024.)

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]

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]

Reconstruction of complex penile defects is always challenging, as some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded in complex wounds. We present a case of a 63-year-old otherwise healthy man, who underwent transurethral resection of the prostate for benign prostatic hyperplasia. After the procedure, he developed panurethral necrosis with consequent stricture. Three urethroplasties for reconstruction of the bulbar and distal urethra using buccal mucosa grafts, a preputial flap, and penile skin were performed by urology team in different institutions, but serious urinary fistulization and carbapenemase-producing Klebsiella pneumoniae (KPC) infection translated in a chronic wound, urethra necrosis, and near-total penile amputation. A composite anterolateral thigh flap and vascularized fascia lata were used with success together with a perineal urethroplasty in different stages, improving the ischemic wound condition. The extended segment of fascia lata was used for Buck's fascia replacement and circumferential reinforcement to cover the erectile bodies of the penis. The postoperative period was uneventful and after 12 months, there were no signs of recurrence or wound dehiscence. He was able and easily adapted to void in a seated position through the perineal urethrostomy that was made. To the best of our knowledge, this procedure has not been reported previously as a salvage procedure in a fistulizated and KPC infected penis, but it may be considered to avoid penile amputation in chronic infected and intractable wounds.

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]

Background: Penile amputation is an emergency urologic condition requiring immediate attention in order to maximize functional outcomes. Unfortunately, there is limited experience and publication of case reports describing the successful replantation of penis after incomplete amputation, especially in facilities without adequate microsurgical tools and means. We hereby present a case of penile amputation caused by a mechanical grass cutter and a discussion of its surgical management. Case description: A 33-year-old Indonesian male presented to the emergency department with incomplete penile amputation six hours post injury. The patient has no prior medical history and presented with penile amputation due to a mechanical grass cutter trauma. He underwent immediate non-microsurgery reconstructive replantation of the penis, reattaching all visible vascular, corporal, and fascia layers. After replantation, the patient recovered well and showed preserved normal appearance and sensitivity of the penis. Subsequent Doppler ultrasound investigation revealed adequate arterial flow at the distal end of the anastomosis. The patient was discharged five days after surgery. Conclusion: In the absence of microsurgical tools and means, the use of non-microsurgical replantation with an at least 2.5x loupe magnification should be the choice of treatment in the case of incomplete penile amputation. The technique showed good outcomes involving adequate functional and cosmetic restoration.

Background: Penile amputation is an emergency urologic condition requiring immediate attention in order to maximize functional outcomes. Unfortunately, there is limited experience and publication of case reports describing the successful replantation of penis after incomplete amputation, especially in facilities without adequate microsurgical tools and means. We hereby present a case of penile amputation caused by a mechanical grass cutter and a discussion of its surgical management. Case description: A 33-year-old Indonesian male presented to the emergency department with incomplete penile amputation six hours post injury. The patient has no prior medical history and presented with penile amputation due to a mechanical grass cutter trauma. He underwent immediate non-microsurgery reconstructive replantation of the penis, reattaching all visible vascular, corporal, and fascia layers. After replantation, the patient recovered well and showed preserved normal appearance and sensitivity of the penis. Subsequent Doppler ultrasound investigation revealed adequate arterial flow at the distal end of the anastomosis. The patient was discharged five days after surgery. Conclusion: In the absence of microsurgical tools and means, the use of non-microsurgical replantation should be the choice of treatment in the case of incomplete penile amputation. The technique showed good outcomes involving adequate functional and cosmetic restoration.

Total phallic reconstruction (TPR) is a reconstructive challenge. To report both surgical outcomes and patient-reported outcomes (PROs) of genetic male patients undergoing TPR utilising a radial artery forearm free flap (RAFFF). A retrospective tertiary referral centre analysis of a series of genetic male patients with penile insufficiency (PI) either due to congenital micropenis, or from traumatic or surgical amputation was conducted. RAFFF phalloplasty was conducted as a multistaged procedure: (1) TPR, (2) glans sculpting with second-stage urethroplasty when indicated, and (3) penile prosthesis implantation. A descriptive analysis of the patient's baseline features, surgical outcomes, and PROs was conducted. A total of 108 patients were enrolled. The median age was 32.5 yr (interquartile range [IQR] 24–46) and median follow-up was 78.5 mo (IQR 30–129). A primary anastomotic urethroplasty was performed in 90 patients (83.4%) and a staged procedure in the remainder. Four patients experienced an acute arterial thrombosis, leading to complete loss of the phallus in two. Immediate surgical exploration saved the flap in two cases of venous thrombosis. Urethral complication occurred in 49.1% of patients. The multivariate logistic regression analysis showed an association (p = 0.04) between the staged urethral reconstruction and the incidence of urethral complications. The limitations of our study are its retrospective nature and the lack of control. Despite the high incidence of postoperative complications and the possible need for revisions, TPR in the genetic male with PI using a RAFFF yields satisfactory aesthetic and functional results. in this report, we looked at the outcomes from TPR in a large population of male patients with penile inadequacy either due to congenital micropenis, or from traumatic or surgical amputation. Our results support the idea that penile reconstruction with a forearm free flap leads to satisfactory outcomes. Despite the high incidence of postoperative complications and the possible need for revisions, total phallic reconstruction in the genetic male with penile inadequacy using a radial artery forearm free flap may yield excellent aesthetic and functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Penile amputation is a rare urological emergency with varying etiologies, ranging from psychiatric disorders to traumatic injuries, and requires precise microsurgical replantation techniques to restore function and appearance. The popularization of microsurgery has greatly improved outcomes by enabling accurate vascular and nerve reattachments, which are crucial for erectile function and sensation. This comprehensive study reviews advancements in microsurgical penile replantation, perioperative, and postoperative care, focusing on the nuances of surgical interventions and potential complications such as ischemia and necrosis. Methods: The PubMed, EMBASE, and Cochrane databases, were queried for studies published between 2015 and 2023 that discussed preoperative conditions, surgical techniques, and postoperative outcomes in penile replantation cases. Resulting studies that reported preoperative and postoperative outcomes of at least one case of penile replantation after amputation were included. Case parameters of interest were then extracted and categorized to determine the most common complications as well as solutions utilized in penile replantation. Results: Our findings from 46 cases across 37 studies revealed a common occurrence of postoperative necrosis (56.5%) and highlighted the importance of timely vascular reconnection and innovative surgical strategies to manage complications. Three cases were complicated by scrotal hematomas and 23 cases reported at least one psychiatric comorbidity. Some innovative solutions mentioned include hyperbaric oxygen therapy, laser angiography, leech therapy, PDE inhibitors, and penile splints. Conclusion: The outcomes suggest a critical need for standardized protocols and further research into optimizing techniques and therapies to enhance the success rates as well as quality of life post-replantation. This review aims to guide future practices and encourage collaborative efforts to refine the complex microsurgical procedures involved in penile replantation., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Author(s).)

• Traumatic penile amputation is a rare surgical emergency that requires immediate care. • Most reported cases involve genital self-mutilation induced by psychiatric disorders. • We report a successful proximal penile shaft amputation via macrosurgical techniques. Traumatic penile amputation is a highly uncommon surgical emergency that requires immediate intervention. Most reported cases involve genital self-mutilation induced by underlying psychiatric disorder, especially schizophrenia. The self-mutilation of external genitals in psychiatric patients, also known as Klingsor syndrome, is a rare form of urotrauma. We present a case of partial penile amputation in a 46-year-old male with Klingsor syndrome admitted to the hospital 3 days after the incident. Urological examination revealed a subtotal cut of the penis, including the distal part of the mons pubis, dorsal and lateral parts of the penile skin, corpus cavernosum, and corpus spongiosum, as well as a partial bulbous urethra rupture. The penis remained suspended by only a thin ventral part of the penile skin. After macroscopic surgical replantation, the patient recovered well and could urinate without any symptoms of urethral stricture. The entire penis remained viable with minimal scarring at the surgical site, and penile erection could be achieved and maintained. The case demonstrates a rare instance of the successful proximal penile shaft amputation via macrosurgical techniques by an experienced urologic surgeon. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcome of a single-center series of penile reconstruction using the radial free forearm flap in rare indications.Materials and Methods: From April 1993 until September 2016, 23 nontranssexual patients underwent phallic reconstruction by the use of a neuromicrovascular free radial forearm flap in our clinic. Patient-specific characteristics, surgical techniques, complications, and outcomes were retrospectively evaluated and interpreted.Results: The indications for surgery were: disorders of sex development (34.8%), reconstruction after oncologic surgery (34.8%), automutilation (8.7%), iatrogenic (8.7%), microphallus (8.7%), and 1 case of priapism (4.3%). Two patients (8.7%) had a total flap necrosis and 2 patients (8.7%) had a partial flap necrosis; 3 out of these 4 patients were heavy smokers. Urinary fistulae and strictures were frequent but were successfully managed by urologists in all cases. There was no statistically significant correlation between smoking, comorbidities, number of venous anastomoses, and complications.Conclusion: In departments experienced in microsurgery, the goals of penile reconstruction could also be achieved in patients with rare indications by the use of the neuromicrovascular free radial forearm flap. Despite the high rate of postoperative complications, penile reconstruction with the free radial forearm flap yields satisfying results. An intensive cooperation between the plastic-reconstructive team and the urological team is a prerequisite to achieve the best surgical result. [ABSTRACT FROM AUTHOR]

Introduction: There is paucity of case reports that describe successful non-microscopic penile reimplantation. We report a case of a self-inflicted penile amputation in an apparently normal patient with first psychotic break. Observation: To report on a case of successful macrosurgical penile reimplantation, discuss the etiologies, surgical techniques and outcomes of world literature on penile reimplantation and an update of current trends in penile surgery. A 40 year-old male, father of 3 children and a proprietor of a nursery school with no prior pschiatric disorder was rushed to our trauma centre following a self-inflicted total penile amputation at its base with incomplete laceration of the scrotum due to command hallucination. He was immediately resuscitated and underwent a non-microscopic penile reimplantation and scrotal closure by an experienced urologist (JEM) by reattaching the dorsal vein, urethra, corporal, fascial and skin layers. A functional outcome with respect to voiding, penile erection and cosmesis was excellent. Conclusion: Self-inflicted penile amputation may manifest as first psychotic break in apparently normal subjects. Though microscopic neurovascular reconstruction is the gold standard, macrosurgical reimplantation of penis by an experienced surgeon in the absence of a microscope yields satisfactory results.

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.

Penile amputation is an unusual situation reported globally as isolated cases and small series. It constitutes a urological emergency which requires microsurgical skills for the repair of the penis. We present a case of a penile amputation and discuss the management of this challenging condition. A 47-year-old patient presented to the emergency room with total amputation of corpora cavernosa of the penis resulting from knife aggression. The patient underwent successful microsurgical replantation, demonstrating positive progression and satisfactory results. Microneurovascular repair of penile amputation is the gold standard. Recommendations include a meticulous anastomosis, and a focus on vein anastomoses for optimal outcomes as well as associating a psychiatric approach. The PENIS score classifies the severity of lesion and predict postoperative complications and main outcomes. Penile amputation presents a distinctive challenge, necessitating microsurgical anastomosis, meticulous tissue management, and adherence to established protocols are imperative for effectively managing such intricate cases. Even in cases of posttraumatic partial penile amputation after a long period, can yield satisfactory morphofunctional outcomes. • Penile amputation is a urological emergency, reported globally as isolated cases, requiring microsurgical approach. • Microsurgical replantation as the gold standard • Microsurgical anastomoses preserve erectile and urinary function • PENIS score classify the severity of lesion and predict postoperative complications and main outcomes. [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.

The paper presents the unique clinical experience of successful sexual rehabilitation of a patient who has undergone penile amputation for cancer. Complex reconstruction of all parts of the lost organ, by using known methods and those proposed for the first time in global practice (balanus repair with transposition of the testis), was performed in the patient.

Abstract 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.

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.

The hair tourniquet syndrome is an unusual phenomenon which can cause severe damage to the affected organ, sometimes even its loss. This problem requires urgent attention and prompt management to ensure anatomical and functional preservation. Herein we report a case of penile hair tourniquet which was successfully managed using the urethral advancement and glanuloplasty incorporated procedure (URAGPI).

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]

Introduction: There is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature. Aim: To report on self-inflicted penile amputation and comment on its surgical management and review current literature. Methods: A 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue. Main Outcome Measures: To review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes. Results: We report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements. Conclusion: We review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53.

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]

Abstract Background A 24-year-old man was urgently transferred from an outside institution after self-amputating his penis. Methods The patient was suffering from a paranoid schizophrenic delusional episode. Voices told him to amputate his own penis with a utility knife. He was taken emergently to the operating room by urology and plastic surgery. Cystoscopy was performed and a 14F percutaneous suprapubic catheter was placed. The amputated distal penis and the proximal stump were debrided. The urethra, dorsal artery, and neurovascular bundles were mobilized. The distal urethra was spatulated dorsally and the proximal urethra was spatulated ventrally. The urethra was reanastomosed over a 16F Foley catheter with interrupted, 4–0 absorbable, monofilament suture. The corpora were reanastomosed with interrupted, 2–0 and 3–0, absorbable, monofilament suture. The arteries and nerve were reanastomosed. Total ischemia time was between 4 and 5 hours. Results The patient initially developed edema, ecchymosis, and mild incisional skin necrosis from the resulting reperfusion injury. However, the penile graft successfully maintained perfusion. He was discharged 2 weeks after his injury in stable psychiatric condition. His Foley catheter and suprapubic tube remained in place for 10 weeks. A voiding cystourethrogram (VCUG) demonstrated a patent urethra without evidence of urinary leakage or stricture. At the time of his VCUG, he experienced return of distal penile sensation and partial erections. Conclusion Penile reimplantation after self-amputation is successful if ischemic time is minimized and a multidisciplinary approach with plastic surgery and microvascular anastomosis is performed.