Reimplantation of an amputated penis in prepubertal boys

Phalloplasty: A Review of Techniques and Outcomes

BACKGROUND

Acquired or congenital absence of the penis can lead to severe physical limitations and psychological outcomes. Phallic reconstruction can restore various functional aspects of the penis and reduce psychosocial sequelae. Moreover, some female-to-male transsexuals desire creation of a phallus as part of their gender transition. Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes.

METHODS

A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through July of 2015 with multiple search terms related to phalloplasty. Data on techniques, outcomes, complications, and patient satisfaction were collected.

RESULTS

A total of 248 articles were selected and reviewed from the 790 identified. Articles covered a variety of techniques on phalloplasty. Three thousand two hundred thirty-eight patients underwent phalloplasty, with a total of 1753 complications reported, although many articles did not explicitly comment on complications. One hundred four patients underwent penile replantation and two underwent penile transplantation. Satisfaction was high, although most studies did not use validated or quantified approaches to address satisfaction.

CONCLUSIONS

Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients.

Traumatic penile amputation in a 15-year-old boy presenting late in northwestern Nigeria

Traumatic penile amputation is a serious urological emergency, although rare whenever it happens, there is a need to refer the patient early to urologist within 24 h, with the stump wrapped in saline; unfortunately, our patient presented late and as such could not benefit from penile reimplantation.

Surgical reimplantation of penile glans amputation in children during circumcision

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.

Surgical management of penile amputation in children

PURPOSE

Penile amputation in children is rare. If the amputated organ cannot be salvaged, standard treatment options include sex reassignment or creation of a penoid with a musculocutaneous flap. We describe our experience with phallic reconstruction after amputation.

METHODS

Between 2005 and 2007, we observed 3 patients with penile amputation. All presented a flat pubic scar and a severe urethral stricture for which urinary diversion had been performed in two. The first step of the procedure was penile augmentation. The latter included dissection and advancement of the residual erectile tissue by either division of the suspensory ligament (n = 2) or detachment of the corpora cavernosa from the pubic bones. Then, meatal advancement was attempted and combined with a staged oral mucosa urethroplasty, if necessary. Finally, skin coverage was achieved using local flaps (n = 2) or a free graft harvested from the inguinal region. In 2 patients, a pseudoglans was sculptured from the pubic scar.

RESULTS

In no case the procedure could be performed in a single stage. In one patient, 2 additional cosmetic revisions were required. Good penile augmentation was achieved in all the 3 cases. All patients presented at least nocturnal erections and reported to be satisfied with the cosmetic results.

CONCLUSIONS

Our experience suggests that an attempt to phallic reconstruction by retrieval of any residual erectile tissue might be worthwhile before embarking on a penile replacement. In a few cases, this may allow recreation of a penis with good cosmesis and function.

Reconstruction after total penile amputation and emasculation

Amputation of the penis and testes is a rare injury in the pediatric population. The authors describe a case of traumatic amputation of the penis and testes presenting late for surgical reconstruction. The surgical reconstruction of this phallus involved advancement of the residual erectile tissue by division of the suspensory ligaments of the penis to lengthen the phallus. A glans penis was fashioned using a full-thickness skin graft with shaft skin provided by a split-thickness skin graft. The use of a tissue expander allowed the creation of a scrotum that accepted two testicular prostheses. Reconstruction of the phallus using these techniques allowed the creation of an erectile, esthetically acceptable phallus. In the situation in which residual erectile tissue remains, this technique can be effectively used in place of musculocutaneous transfer flaps or gender reassignment.