title: Penile Replantation: A Retrospective Analysis of Outcomes and Complications.
abstract: PurposePenile replantation is an uncommonly performed procedure, which can alleviate physical and psychosocial sequelae of penile amputation. This study critically appraises the current literature on penile replantation.MethodsA comprehensive literature search of the Medline, PubMed, and Google Scholar databases was conducted with multiple search terms related to penile replantation. Data on outcomes, complications, and patient satisfaction were collected.ResultsA total of 74 articles met inclusion criteria. One hundred and six patients underwent penile replantation, but outcome, complication, and satisfaction data were not standardized across all patients. Penile amputation most often resulted from self-mutilation or trauma. The majority were complete amputations (74.8%). Full sensation was maintained in 68.4% of patients. Most reported adequate urinary function (97.4%) and normal erection (77.5%). Skin necrosis (54.8%) and venous congestion (20.2%) were the most common complications. Urethral stricture (11.0%) and fistula (6.6%) were common urethral complications. Most (91.6%) patients reported overall satisfaction although there was a lack of patient-reported outcomes. Multivariate analysis suggested that complete amputation (β = 3.15, 95% CI 0.41-5.89,p= 0.024), anastomosis of the superficial dorsal artery (β = 9.88, 95% CI 0.74-19.02,p= 0.034), and increasing number of nerves coapted (β = 1.75, 95% CI 0.11-3.38,p= 0.036) were associated with favorable sexual, urinary, and sensation outcomes. Increasing number of vessels anastomosed (β = -3.74, 95% CI -7.15 to -0.32,p= 0.032) was associated with unfavorable outcomes.ConclusionAlthough penile replantation is associated with complications, it has a high rate of satisfaction and efficacy. Coaptation of multiple nerves and anastomosis of the superficial dorsal artery should be completed.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Shane D
authors.initials: SD
authors.lastname: Morrison
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Afaaf
authors.initials: A
authors.lastname: Shakir
authors.affiliation: Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Krishna S
authors.initials: KS
authors.lastname: Vyas
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Austin C
authors.initials: AC
authors.lastname: Remington
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Kentucky School of Medicine, Lexington, Kentucky.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mogni
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York.
authors.forename: Stelios C
authors.initials: SC
authors.lastname: Wilson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University of St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: David W
authors.initials: DW
authors.lastname: Grant
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Cho
authors.affiliation: Division of Transplant Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Rahnemai-Azar
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Friedrich
authors.affiliation: Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
mesh_terms: D000673:Amputation, Traumatic / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery; D017060:Patient Satisfaction; D010413:Penis / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology* / Q000523:psychology; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D012652:Self Mutilation / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014481:United States; D014521:Urethra / Q000601:surgery; D014554:Urination / Q000502:physiology