Microscopic Replantation of Penile Glans Amputation Due to Circumcision

Summary

The present protocol describes the emergency management of microscopic replantation of penile glans amputation due to circumcision.

Abstract

Circumcision using a disposable stapler is becoming quite popular in China. However, improper surgical procedures also bring the risk of penile glans amputation, which is a very rare iatrogenic genital injury. Such complication is conventionally treated by simple hemostasis to achieve self-healing, early gross replantation, or delayed plastic surgery. However, these may lead to obvious unfavorable outcomes such as amputated glans loss, necrosis, malformation healing, or urethral orifice stenosis. In the present study, we adopted microscopic replantation as an emergency approach to achieve the precise anastomoses and anatomic reconstruction of penile glans. The goal of this protocol is to present a detailed emergency management strategy with meticulous surgical skills for the penile glans amputation. The postoperative results showed that the original shape of the glans was perfectly restored with satisfactory cosmetic appearance. The micturition function was completely restored to normal without any obvious complications. There was also no significant reduction in the sensation of amputated glans area. Hence, early meticulous microscopic replantation as soon as possible is an ideal emergency management strategy for the penile glans amputation due to circumcision.

Introduction

Around 25% of men worldwide are circumcised^1,2. Circumcision in China is mostly performed in childhood. Over the past decades, the improvements in surgical techniques and equipment have made circumcision less complicated, faster, and with fewer post-circumcision complications. However, the popularity of these devices has also brought new challenges.

The incidence of post-circumcision complications is around 1%-20%, mostly mild^3,4,5,6,

Protocol

The protocol was carried out in accordance with the principles of the Helsinki Declaration and all the methods described here have been approved by the ethics committee of Daping Hospital and written consent was obtained from the patients.

1. Instruments for operation

1. Conduct all the procedures under an operating microscope with 5-10x magnification to achieve precise anastomoses and anatomic reconstruction.

2. Inclusion and exclusion criteria

1. Use the following inclusion criteria: patients who experience penile glans amputation during circumcision; t....

Results

Three 7-8 years old children, whose distal penile glans were completely (2 cases) or incompletely (1 case) amputated during circumcision using a disposable stapler, were admitted to the hospital within 2-3 h after injury from June 2019 to July 2021. Physical examination confirmed that about 1/3 of the distal end of the penile glans with 3-4 mm of distal urethra was completely or incompletely amputated. In one severe case, the inner plate of prepuce and frenulum on the ventral side of the glans were also seriously damaged.......

Discussion

For religious or therapeutic purposes, about one-quarter of men around the world have had circumcision¹. The incidence of complications is far from negligible, approximately 1% to 20%^3,4,5,6,7. Circumcision-related glans amputation is extremely rare and there are no exact statistics depicting its incidence. Owing to its rarity, previous.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Catheter	Guangzhou Weili Co., Ltd	12 Fr
Cefuroxime sodium	Yiyi Saite, Co., Ltd	0.75 g
Cis-atrecu besylate	Jiangsu Dongying CO.,  Ltd	10 mg
Operating microscope system	Carl Zeiss Co., Ltd	OPMI VARIO 700
Pentylpheptyl ether hydrochloride	Chengdu Lisi Co., Ltd	1.0 mg
Prolene	Ethicon, LLC	W2777/2780
Sufentanni citrate	Renfu Phermaceutical	50 µg
Vicryl	Ethicon, LLC	W9981