Purpose Statement

Self-emasculation, often the result of acute psychosis, has been reported in the literature. Technically, replantation of the amputated penis is challenging but feasible. The goals of replantation are to achieve a viable and sensate penis with both urinary and erectile function. We report a case of self-inflicted penile amputation that used microsurgical techniques in combination with medicinal leech therapy for a successful penile replant.

Methods and Materials

Because corporal vessels cannot be surgically anastomosed, they are prone to develop hematomas. Postoperative corporal hematoma can result in venous congestion, flap failure, or compartment syndrome. We used leeches in the immediate postoperative period to treat an evolving corporal hematoma.

Summary of Results

The evolving corporal hematoma resolved and penile flap edema was controlled, resulting in a successful penile replantation. One complication occurred secondary to positioning, resulting in localized hemorrhage and a suture line dehiscence. The penis remained viable and the patient was electively taken back to the operating room for debridement and local skin flap coverage to protect the microsurgical anastomoses.

Conclusions

Replantation is a realistic option after self-emasculation. Preemptive leeching minimizes corporal hematoma following penile microsurgical replantation. Postoperatively, cautious patient positioning is essential.