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

## TL;DR

A rare case of a schizophrenic patient self-amputating his genitals is reported, highlighting the challenges in replantation and the importance of timely microsurgical intervention.

## Contribution

This case report adds to the limited literature on genital self-mutilation and emphasizes the critical role of early microscopic replantation.

## Key findings

- Bilateral testicular and penile self-amputation is an extremely rare condition.
- Prolonged ischemia significantly reduces the success rate of replantation.
- Microscopic surgical techniques are essential for successful replantation when feasible.

## Abstract

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.

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.

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.

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

•Bilateral testicular and penile self- amputation is one of the rarest forms of self-amputation.•Prolonged ischemia time has detrimental effect in successful replantation of the severed organ.•If it is possible replantation of organs should bed done using microscopic surgery.

Bilateral testicular and penile self- amputation is one of the rarest forms of self-amputation.

Prolonged ischemia time has detrimental effect in successful replantation of the severed organ.

If it is possible replantation of organs should bed done using microscopic surgery.