Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)

Authors

1 Departments of Urology, Kerman University of Medical Sciences, Kerman, Iran

2 Departments of Plastic Surgery, Kerman University of Medical Sciences, Kerman, Iran

10.4103/atr.atr_13_17

Abstract

Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self‑mutilation.
Eighty‑seven percent of the self‑mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular
anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health‑care team.
A 25‑year‑old male patient presented to our emergency department with self‑inflicted PA. As he had a history of some psychiatric problems,
psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however,
they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine
specialist consultation, we took the coroner’s warrant for emergency surgical intervention and transferred the patient to the operating room
without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on
the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed
at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics.
Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives
could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases.

Keywords


1. Muangman V. Amputated penis, a man’s nightmare. Thai J Surg
1980;1:84‑5.
2. May J, Sadigh P. Penile replantation in an acutely psychotic patient.
Anat Physiol 2013;5:170.
3. Ehrich W. Two unusual penile injuries. J Urol 1929;21:239‑41.
4. Cohen BE, May JW Jr., Daly JS, Young HH. Successful clinical
replantation of an amputated penis by microneurovascular repair. Case
report. Plast Reconstr Surg 1977;59:276‑80.
5. Kochakarn W. Traumatic amputation of the penis. Braz J Urol
2000;26:385‑9.
6. Sweeny S, Zamecnik K. Predictors of self‑mutilation in patients with
schizophrenia. Am J Psychiatry 1981;138:1086‑9.
7. Nakaya M. On background factors of male genital self‑mutilation.
Psychopathology 1996;29:242‑8.
8. Marsh HP. Patient consent for surgery. In: Muneer A, Pearce I, Ralph D,
editors. Prosthetic Surgery in Urology. Cham: Springer International
Publishing; 2016. p. 43‑6.
9. Parsapoor MB, Ghasemzadeh SR. Legal and jurisprudential study of patients
informed consent and physicians duty of notification: A comparison between
Iranian, English and French law. Iran J Med Ethics Hist Med 2011;5:39‑50.
10. Ghaderi A, Malek F. Principles of informed consent in medicine.
Koomesh 2013;1:133‑7.
11. Jordan GH, Gilbert DA. Management of amputation injuries of the male
genitalia. Urol Clin North Am 1989;16:359‑67.