Penile Amputation with Primary Reanastomosis and Post-Operative Leech Therapy

Introduction/Purpose: To date self-amputation of the penis remains a rarity. There is little evidence to support the best management strategies and is typically left to relying upon expert opinion. Our case describes a 28-year-old male under immense psychological stress amputating his penis, and management with primary microscopic reanastamosis.

Methods or Case Description: a 28-year-old male with a history of depression presents to the emergency department after penile self-amputation. Upon presentation the penis was unavailable, however, was delivered within 4 hours of the inciting event. After amputation an approximately 5 mm urethral stump remained. After discussion with family, social work, and the urologic team the decision was made for primary microscopic anastomosis, given the success reported by expert opinion. Post-operatively the patient required leech therapy to aid with venous pooling and survivability. Throughout his post-operative course ultrasound demonstrated good arterial flow throughout the penis, however due to venous pooling and poor blood flow to the penile skin the skin, the foreskin and penile skin began sloughing. The patient then elected to proceed with formal penectomy opposed to skin grafts placement. which would lead to a more difficult and tedious recovery, with unknown success rates.

Outcomes: We were able to demonstrate good arterial flow throughout the penis. Good arterial flow with poor venous outflow led to significant venous pooling requiring leach therapy. After approximately 6 weeks the patient elected for penectomy instead of proceeding with further management with penile skin grafts.

Conclusion: In conclusion, penile amputation remains a rarity in urology. Undertaking expert opinion primary reanastomisis is possible and time sensitive. Major challenges arrive not with the initial surgery but post-operative complications f many times leading to eventual penectomy despite best surgical efforts.