Successful Replantation of a Traumatically Amputated Penis in a Neonate

This is a report of a case of traumatic amputation of the penis in a 10-day-old neonate. The amputation was performed accidentally under far from sterile conditions in a village by an untrained barber, trying to do a circumcision. Replantation was successfully performed.

Index words: Penis, traumatic amputation.

Thirteen cases of replantation of the penis as a composite graft have been reported. Most of these cases were followed by complications such as distal skin necrosis, fistula or stricture. Two cases of replantation with microvascular anastomosis have been reported with success but these also developed slight constriction at the site of urethralanastomosis.^2,3

CASE REPORT

The child was brought to the Mosul University Teaching Hospital with the penis dangling from the root by a narrow strip of skin attached ventrally to the scrotum. The penile stump was wrapped in a dirty rag and no effort was made tokeep the organ cool during transportation.

Soon after arrival in the hospital, the infant was taken to the theatre, and on examination, there was no evidence of circulation in the distal penile stump, which looked blue (Figs. 1 and 2). The wounds on either side were gently cleaned, the edges of the Buck's fascia and skin on both sides trimmed and sutured, using interrupted chromic 4-0 gut for the fascia and 5-0 silk for the skin. The corpora was not sutured. No vessels were anastomosed. Suprapubic cystostomy was performed for urinary diversion. and a ureteric catheter was used as a splint for the urethra. In the postoperative period low molecular weight dextran and heparin, 2500 U every 8 hr (s.c.) were administered. Both were withdrawn on the third postoperative day, when, after an initial period of congestion the penis gradually regained normal color. On the tenth postoperative day, the suprapubic tube was removed but the urethral splint was retained till the 14th day when the patient was observed to pass urine per urethra by the side of the catheter. The patient was passing urine normally after 8 wk. Both the size and the strength of the stream appear to be normal. Urethrogram taken after 8 week shows no evidence of stricture or leak (Fig. 3). Glandulal stimulation produces erectile response in the penis.

Figs. 1 and 2. Showing the penis attached to its root by a narrow strip of skin.

Fig. 3 Urethrogram taken at 8 wk showing no evidence of stricture or fistula.

DISCUSSION

This is the youngest patient on whom a penile replantation has been performed. The time interval as well as the condition in which the patient was transferred before beingtreated in the hospital were far from ideal.

The author feels that the small connecting tag of skin could not be an adequate source of blood supply for the replanted penis because, preoperatively, the distal penile stump had no circulation. He shares the view⁴ that the circulation is reestablished through the spongy tissue of the penis. Experimental work by Raney et al.⁵ supports this view. It is still too early to know if a stricture willdevelop in this case.

ACKNOWLEDGMENT

I wish to thank Professor S.S. Rawat for very kindly reviewing the manuscript. Dr. I.A. Al-Hatim F.R.C.R. Assistant Professor in Radiology, and Toran Adham and Ahmad Kassim for the photographic assistance.

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