# Experience in non-microscopic surgical management of complete penile amputation in a resource-limited setting: a case report

## TL;DR

A man in Ethiopia underwent successful non-microsurgical penile replantation after amputation, showing good recovery in a setting with limited resources.

## Contribution

Demonstrates successful non-microsurgical penile replantation in a resource-limited setting with a 10-hour ischemia period.

## Key findings

- Non-microsurgical replantation achieved good functional and cosmetic outcomes.
- Viability was maintained without microvascular anastomosis, likely due to the corporal blood supply.
- The case supports non-microsurgical repair as a viable alternative when microsurgery is unavailable.

## Abstract

Penile amputation is a urologic emergency requiring prompt treatment to optimize outcomes. This report focuses on a case of self-inflicted penile amputation, its surgical management, and a review of current literature.

A 40-year-old Ethiopian male with a known psychiatric illness arrived at the emergency department eight hours after a complete penile amputation. He underwent non-microsurgical replantation, reconnecting the corporal, fascial layers, and skin. Post-surgery, he recovered well with good erectile function, preserved sensation, and an acceptable appearance. He was discharged six weeks later.

While microsurgical replantation is considered the gold standard, emerging evidence suggests that non-microsurgical techniques can achieve favorable outcomes, particularly when performed within a critical ischemia window. This case supports previous findings that penile replantation without microvascular anastomosis can still restore organ viability, adequate urinary function, and satisfactory sexual outcomes. The report underscores the potential role of corporal blood supply in maintaining penile perfusion even without vascular re-anastomosis.

In cases of complete penile amputation without microsurgical tools, gross replantation is the preferred treatment, offering good functional and cosmetic outcomes.

•Non-microsurgical penile replantation achieved good functional and cosmetic outcomes.•Successful replantation despite 10-hour ischemia in a resource-limited setting.•Viability maintained without microvascular anastomosis, likely due to corporal blood supply.•Postoperative recovery included wound healing, urinary function, and erectile restoration.•Findings support non-microsurgical repair as an alternative when microsurgery is unavailable.

Non-microsurgical penile replantation achieved good functional and cosmetic outcomes.

Successful replantation despite 10-hour ischemia in a resource-limited setting.

Viability maintained without microvascular anastomosis, likely due to corporal blood supply.

Postoperative recovery included wound healing, urinary function, and erectile restoration.

Findings support non-microsurgical repair as an alternative when microsurgery is unavailable.