Self-inflicted penile and testicular amputation: A very rare case report and treatment dilemma in the absence of microsurgical service.

INTRODUCTION AND

IMPORTANCE

Genital self-mutilation is a rare urologic surgical emergency that is usually encountered in patients with underlying psychiatric illness. Because of shortage of published data and variance in management schemes worldwide, these conditions can present a significant management dilemma.

CASE PRESENTATION: In this case report we present this rare phenomenon, where a known schizophrenic patient presented after he amputated both of his testes and penis under the influence of command hallucination. After 15 h of the incident, macroscopic replantation of the severed genitalia was done and psychiatric evaluation and management initiated simultaneously. But the replantation failed after 9th post operative day.

DISCUSSION: Initial management of patients presenting with genital amputation should be resuscitation. The severed organ has to be washed with sterile saline and placed in "double bag". There are multiple factors for the success of replantation, the major ones are cooling of the amputated organ and precise microsurgical replantation.

CONCLUSION

Early intervention and microscopic replantation are crucial for the successful outcome.