Successful Penile Replantation Following Amputation During Neonatal Circumcision: Case Report and Systematic Review.

BACKGROUND

Neonatal circumcision in Australia has a prevalence of 10%-20%, performed primarily for religious or cultural reasons, with fewer cases for medical indications. Approximately 63% of traumatic pediatric penile injuries are circumcision-related.

METHODS

This study includes a systematic review and a case report, examining the incidence, mechanism, and management of penile amputation following circumcision in children. It compares surgical techniques (microvascular versus composite grafts), postoperative care (eg, leech therapy, vasodilators), and long-term outcomes.

RESULTS

A systematic search of PubMed and Embase databases identified 26 relevant case reports. Four involved microvascular replantation, and 22 used composite grafts without neurovascular anastomosis. Of the 4 microvascular cases, 3 included glans and shaft injuries, and 1 involved a glans-only injury. All achieved good urinary function and erections at follow-up. Two experienced complications-1 infection and 1 case of skin necrosis-both managed conservatively. Among the 22 composite graft cases, 20 involved glans-only injuries. Most reported good function and cosmesis. Seven cases had complications, including meatal stenosis, partial necrosis, hypoplasia, and fistula formation, requiring further surgery. We also report a case of an 8-day-old male patient who sustained subtotal penile amputation during a home circumcision using a Mogen clamp. Emergency re-anastomosis of the superficial dorsal artery and urethral and corporal repair were performed. Postoperatively, he received leech therapy, antibiotics, sildenafil, and transfusions, with a favorable recovery at 12 months.

CONCLUSIONS

Composite grafts may yield acceptable results for glans-only injuries. For more extensive trauma, microvascular replantation should be pursued where possible. Leech therapy can aid venous outflow but often necessitates transfusion.