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RECONSTRUCTIVE
UROLOGY
Microsurgical
replantation of sexual organs in three patients
Galek L, Darewicz B, Kudelski J, Werel T, Darewicz J
From the Department of Urology, Medical Academy of Biaystok, Poland
Scand J Urol Nephrol. 2002; 36:14-7
- Objective:
The present study deals with microsurgical replantation technique.
- Material
and Methods: The technique was applied in 3 patients whose sexual
organs had been accidentally cut off.
- Results:
Necrosis of the sutured organs occurred in 2 cases. In 1 case, however,
healing with proper miction and sexual function was achieved. Prolonged
period (over 12h) from the accident to operation as well as the extensive
injury of tissues with the vascular system crush were considered to
be the main reason for failure.
- Conclusions:
Microsurgical reconstruction of penis and testes with the use of vessel
grafts prolonged the hypoxia, which led to necrosis. Disturbances in
vein blood outflow from the sutured organs contributed to this process
as well. The third case resulted in success mostly due to quick intervention
(5h from injury) as well as to proper microsurgical reconstruction of
vessels, nerves, and urethra. In addition, suprapubic urine diversion
was successfully applied and the urethra healed on the perforated catheter.
Routine antibiotics as well as antithrombotic prophylactics were administered
in all of the 3 cases.
- Editorial
Comment
The authors presented 3 cases of genital traumatic amputation (1 case
of penis, scrotum and testis, and 2 cases of penile amputation). Only
1 case was successfully replanted. The authors concluded that quick
intervention and proper storage of the amputed organs are of utmost
importance for successful genital organs replantation. Since testes
are more sensitive to anoxia and one gonad is sufficient for proper
endocrine and reproductive function, the authors proposed to start the
operation with one testis implantation followed by penis replantation,
in cases of complete genitals amputation.
Penile amputation is an uncommon injury and 87% of the patients had
psychiatric problems. Since 1970 in Thailand, there had been an epidemic
of penile amputation as philandering punishment by humiliated wives.
Dr. Kochakarn from Mahidol University, Bangkok, Thailand, reported recently
an impressive personal series of 25 penile reimplantations (1,2). He
reported that the amputated part can be maintained up to 16 hours or
may be up to 24 hours at hypothermia. In short, his reimplatation technique
is: urethral mucosa of both ends approximated by interrupted 6-0 chromic
catgut and the adventitia and corpus spongiosum by 4-0 or 5-0 polyglycolic
acid; under 8-16 X microscopic magnification, perform meticulous dissection
to find the healthy dorsal arteries is vital for successful anastomosis
by 11-0 monofilament nylon both dorsal arteries (1 mm in diameter) and
dorsal vein (3 mm in diameter); perineurorhaphy of the dorsal nerve
with 9-0 or 10-0 nylon suture; and finally, dartos fascia is approximated
by interrupted 5-0 or 6-0 polyglycolic acid. A percutaneous suprapubic
cystostomy catheter is inserted. The adequate cosmetic restoration of
the penis is satisfying and erection returns in nearly all cases, making
intercourse possible. Although the penile sensation showed some decreasing,
the recovering is remarkable. The most common complication is skin loss.
References
1. Kochakarn W, Maugman V, Krauwit A, Saksri B, Chaivanichsiri P, Dmochowski
R: Traumatic penile amputation: results with primary reattachment. J Urol.
1997; 157 (suppl. 4): 220 (Abst. 857).
2. Kochakarn W: Traumatic amputation of the penis. Braz J Urol. 2000;
26: 385-9.
Dr.
Francisco J.B. Sampaio
Urogenital Research Unit
State University of Rio de Janeiro
Rio de Janeiro, RJ, Brazil
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