Penile Amputation: Causes Symptoms And Treatment
Penile injuries are uncommon and can be classified according to their location, extent, and anatomical pathology. Generally, according to the presence or absence of skin injury, it is divided into closed injury and open injury. The so-called penile amputation injury refers to the amputation of the skin, subcutaneous tissue, corpus cavernosum and urethral body of the penis, which is divided into two types: complete and incomplete.
Causes of penile amputation injuries
The resulting penis mutilation can be seen in gunshot wounds in war, mechanical accidents, traffic accidents and injuries to others, as well as self-mutilation or castration. The latter is generally considered to be the most common cause.
Animal bites: Animal bites are relatively rare. They often occurred in rural areas. Now, due to the increasing number of people who like pets, cats and dogs are bitten by cats and dogs. It has been reported that animal bites in the United States account for 1% of emergency room visits, of which 60% to 70% are children. Dog bites account for the majority, especially the damage to the penis and scrotum.
Animal bites may present with avulsion of the penis skin, loss of the penis, or combined urethral injury. Post-injury may lead to potential harm, resulting in soft tissue damage, infection, urethral stricture and, in severe cases, sexual function.
Symptoms of a penile amputation injury
After the penis was severed, the patient looked pale, had cold limbs, decreased blood pressure, and appeared in shock due to excessive blood loss. The severed penis stump bleeds obviously, and it is not easy to stop the bleeding. If the distal end of the amputation is traumatized or bitten by an animal, the wound surface will be irregular and the contusion will be obvious; if the wound is cut with a knife and scissors, the wound surface will be neat and the replantation will be easy to survive.
When the patient sees a doctor, it is necessary to ask whether there is any previous mental and neurological disease, the motive of self-mutilation or the cause of the accident, the time of cutting, the amount of bleeding, the degree of injury, the blood circulation of the wound and the degree of local pollution, and whether the perineum, scrotum, Testicular damage and the presence or absence of posterior urethra and bladder damage.
Prevention and treatment of penile amputation injuries
The family members of patients with mental problems should pay attention to their daily life care. If it is caused by trauma, prevention is generally to pay more attention in daily life and try to avoid dangerous behaviors.
Medicine treatment of penile amputation injury
It is a penile cutting injury caused by self- injury, psychological counseling and evaluation of psychological stability should be carried out first during treatment; then local treatment of trauma should be considered. Because even if the repair surgery is successful, nearly 5% of patients will self-harm again. The survival rate of amputated penis replantation is higher because penile tissue is more resistant to ischemia than other organs. This may preserve survival; cryopreservation of the dissociated site slows the function of intracellular enzymes, reducing the cell ‘s need for sugar, oxygen, and nutrients, thereby prolonging ischemic survival. Wei reported that the penis with warm ischemia time of 16h and the penis with low temperature ischemia for 24h were successfully replanted. It is generally believed that if warm ischemia exceeds 24 hours and cold ischemia exceeds 72 hours, replantation survival is impossible.
Penile replantation surgery should be carried out by microsurgical techniques, which can significantly improve the replantation survival rate and restore sexual intercourse ability. First of all, careful debridement should be done to preserve the viable tissue as much as possible, and to identify the structures that need to be anastomosed at both ends, such as suprapubic cystostomy. To stabilize the penis during replantation, a Foley’s catheter was inserted through the external urethra. Re-docking starts with urethral anastomosis, and then anastomoses the cavernous artery with 10 “0” non-absorbable nylon thread; the tunica albuginea is continuously sutured with 4 “0” Dexon thread to make it tightly closed; followed by anastomosis of the dorsal artery, vein, and dorsal nerve. To protect the vascular nerve bundles, the superficial fascia was sutured with 5″0″ Dexon suture, and finally the skin was sutured. If the dorsal penile artery cannot be anastomosed, at least the dorsal penile vein should be anastomosed. Adequate venous return is an important factor to ensure survival. In the past, only simple sutures of the urethra, tunica albuginea, and skin were used for amputation of the penis, also known as “cavernous body docking”. Penile lymphedema, necrosis of the glans, or sexual function is often seen after surgery. for disconnection Inactivation of distal penile defect, only penile reconstruction surgery can be performed.
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