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
urethral anastomosis.[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 to keep 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  Both were withdrawn on the third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
being treated 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 view[4] 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
will develop 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.

                        REFERENCES

   1.  Engelman ER, Polito G, Perley J, et al: Traumatic
       amputation of the penis J Urol 112:774-777, 1974

   2.  Cohen BE, May JW Jr, Daly JSE, et al.: Successful
       clinical replantation of an amputated penis by
       micro-nuerovascular repair.  Plast Reconstr Surg
       59:276-280, 1977.

   3.  Tamai S, Nakamura Y, Motomiya Y: Microsurgical
       replantation of a completely amputated penis and
       scrotum. Plast Reconstr Surg 60:287-291, 1977.

   4.  Mendez R, Kiely WF, Morrow JW: Self-emasculation. J
       Urol 107:981-985, 1972.

   5.  Raney MA, Maneis H, Zimskind PDA: Reasastomosis of
       completely transected penis in Canine. Urology
       6:735-737, 1975.

------------------------------------
       From the Department of Surgery, Mosul University
College of Medicine, Ninavad, Iraq.
       Address reprint requests to Asal Y. Izzidien, F. R.
C. S., Department of Surgery, Mosul University College of
Medicine, Ninavah, Iraq.
       Copyright 1981 by Grune & Stratton, Inc.
       0022-3468/81/1602-0020501.00/0

(April 1981)

(transcribed 17 July 1996)