Microscopic replantation of penile glans amputation due to circumcision. Glans amputation during circumcision is an extremely rare, but devastating complication. Such complication is conventionally treated by simple hemostasis to achieve self-healing, early gross replantation or delayed plastic surgery which leads to obvious complications such as amputated glans loss, necrosis, malformation healing or urethral orifice stenosis.
It is thus clear that this damage often results in permanent damage to penile appearance and function, along with psychological problems if not handled properly. We developed a new emergency strategy using microscopic technique to achieve an early precise anatomic replantation and reconstruction. The patients were injured during the operation of circumcision using disposable stapler.
The distal penile glans was completely or incompletely amputated. There are three main steps in total. Step one, repair the amputated penile glans and frenulum.
Apply 8-0 nonabsorbable thread to suture the inner cavernous incision of the glans. Meanwhile, use 6-0 absorbable thread to suture the tears on the surface of the glans. Step two, end-to-end urethral anastomosis.
Align the amputated glans and frenulum with the stump of glans. Insert an 8Fr, Foley catheter via the urethral orifice for the drainage of urine. Perform end-to-end urethral anastomosis using 6-0 absorbable thread by intermittent suture method with precise positioning.
Usually, suture one stitch at 12:00 and six o'clock of the urethra at first, and then on the base of two positioning points, suture about four stitches tightly on the left and right sides respectively in a counterclockwise or clockwise direction. Step three, anastomosis of amputated glans surface and reconstruction of the frenulum. Suture the edge of amputated glans to the edge of the penile stump using 6-0 absorbable thread.
Suture a few fixed points at six, 12, nine, and three o'clock at first, and then suture the space between the fixed points with a space of one millimeter for each to achieve a precise anastomosis. Trim the excess inter plate of prepuce on the ventral side of the penile glans. Reconstruct the frenulum by intermittent suture to achieve a satisfactory shape.
The penile glans of the three patients are repaired satisfactorily and normal appearances are achieved after surgery. Postoperative observation at different time. One day after operation, the glans area is dark red and congested.
One week after operation, the surface of the replanted glans and frenulum turn blackish, which might be epidermal scabby tissue. One month after operation, the morphology of the glans basically returns back to normal, with little blackish scabs. Two months after operation, the morphology of the glans returns back to normal.
Two years after the operation, the morphology of the glans and urination are completely normal. Representative outcomes. Three children aged seven to eight years, penile glans were completely or incompletely amputated during the operation of circumcision using a disposable stapler, were admitted to our hospital from June 2019 to July 2021.
The cold and warm ischemia time was from zero to five and half an hour. The operative time was about two hours. The follow-up results showed that the penile glans of all the children healed very well.
The original shape of the glans was perfectly restored and get satisfactory cosmetic appearance without any obvious complications. Conclusions, early meticulous microscopic replantation as soon as possible is an ideal early emergency treatment method for the penile glans amputation, which can achieve a perfect cosmetic appearance without any obvious complications or functional deficiency.
