Danger Down Under: A Pediatric Case of Penile Trauma with a Saw

ABSTRACT

Partial penile amputation in the pediatric age group is an emergency and occurs mainly due to iatrogenic trauma or road traffic accidents. Such lesions are incapacitating and have a devastating psychological impact. We present the case of a 16-year-old boy who presented with an accidental, near-total penile amputation, and highlight our management plan as a favorable one.

INTRODUCTION

Partial penile amputation is an infrequent but traumatizing event that can arise from a multitude of sources, including accidents, abuse, medical procedures, and congenital anomalies.[1] Pediatric urologists face a unique challenge in addressing this issue, necessitating both immediate interventions and long-term considerations for the child’s physical and emotional well-being.[2]

Beyond the immediate medical implications, the psychological and emotional consequences for the child and their family cannot be overlooked. The psychological impact of such an incident on the child’s self-esteem, body image, and overall psychosocial development demands thorough consideration. Addressing these aspects comprehensively is pivotal in ensuring holistic care for the affected child and their support network. This case report seeks to highlight the possibility of primary suturing of a partial penile amputation, to preserve the penile tissue and have a favorable impact on the overall well-being of the child.

CASE REPORT

A 16-year-old boy was brought to the ER with an alleged history of injury to his genitalia while he was cutting wood with an electric saw. Examination of his genitalia revealed profuse bleeding in the region, with a ragged near total penile amputation [Figure 1]. He was resuscitated and catheterization was attempted upon which the catheter was noted to come out of the wound. A pressure dressing was applied and was immediately prepared for operation. Intraoperatively, under a general anesthetic, a near total transection of the phallus distal to the symphysis pubis was noted. The corporal bodies were bleeding profusely with a complete ragged transection of the right corporal body and a near-total transection of the left corporal body. The urethra was catheterized, approximated and urine flow was noted. Corporal hemostasis was achieved using 3-0 vicryl and the transected edges were approximated. A suprapubic cystostomy was done for urinary diversion. This proved adequate to achieve the functionality of the penis. A penile ultrasonography and Doppler done postoperatively showed preserved vascularity.

Figure 1.

(a) Partial corporal amputation with urethral transection, (b) Catheter in transected urethra, (c) Approximation of corporal bodies,(d) Reconstructed phallus with good urinary stream

A retrograde urethrogram and micturating cystourethrogram showed no extravasation of the contrast and the posterior and anterior appear normal in caliber and outline [Figure 2]. The healing went on well albeit with superficial scarring. On discharge, the skin cover was complete. Reassessment at 6 months and 1 year showed minimal scarring and cosmetically good results. Sensitivity to the touch was preserved. The patient reported a mild degree of painful erection and curvature that was not bothering him.

Figure 2.

Retrograde urethrogram/micturating cystourethrogram (RGU/MCUG): Passage of contrast through the posterior and anterior appear normal in caliber and outline. No evidence of extravasation

DISCUSSION

Traumatic penile amputation in the pediatric age group is rare. Total thickness corporal amputations with urethral injuries are relatively uncommon. Common etiologies for these injuries include iatrogenic trauma, traffic accidents, dog bites, and zipper injury with self-amputation only accounting for 7% of all pediatric penile traumas. The management plan is usually varied.[3] Some papers highlight deferred urethroplasty to be the best option.[4] However, primary closure of our patient’s penile injury was completed with no evidence of complication and normal urinary and erectile function on the medium-term follow-up. This good result can be attributed to the transection being a clean-cut injury[5] on account of the sharp saw and early intervention. Children also heal relatively as well as compared to adults. However, follow-up is of prime importance as appropriateness can only be determined after puberty.

CONCLUSION

Surgical repair of an amputation to the penis should be undertaken as an emergency. A primary repair can be considered, and a simple end-to-end anastomosis is sought with a good clinical and functional outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.