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Penis amputation is
infrequent in North America, with most amputations the result of self
inflicted injuries. Less common are machinery accidents and
assaults. Replantation or reattachment of the penis can be performed
if the amputated part is in good condition, has been preserved
appropriately and the ischemic insult is not too severe.
A significant
quantity of blood can be lost in this type of injury, and as in most
amputation injuries, the patient is fully evaluated with a trauma work-up
and any psycho-social issues must be evaluated.
If replantation is
considered an option, the part is prepped separately and dissected under
magnification to identify and tag neurovascular structures. With the
patient asleep, the operative procedure requires a supra-pubic cystostomy
and placement of a foley catheter through the urethra of the amputated
part and proximal stump and into the bladder. The urethra is then
repaired with absorbable suture under loupe magnification. Attention
can be turned to the corpora, which are repaired with absorbable suture
and neatly approximated. After the proximal stump has been dissected
and an inflow artery and outflow vein identified, the arterial repair is
performed under magnification. A venous repair follows and the
dorsal nerves must each be repaired. Mutilation of the part at the
site of amputation may require shortening or vein grafting.
If the suture line
pressure from edema is present and potentially obstructive venous or
arterial drainage, a skin graft can be placed over the vascular and nerve
repairs. Vascular insufficiency may require
leeching.
Post-operative care
consists of drainage via the suprapubic catheter, elevation and aspirin,
usually in conjunction with dextran. When the survival of the part
is certain, the patient can be discharged with a suprapubic catheter.
When the urethral catheter is felt to be ready to be discontinued, the
suprapubic catheter is not removed until it is certain the patient can
void adequately. |
