In a medical first, surgeons in the United Kingdom have successfully completed a penis reattachment — nearly 24 hours after the man cut his organ off of his body during a psychotic episode.
There have been only a handful of penile replantation surgeries in history, but almost none had been without blood supply for more than a few hours. Nearly six weeks after the operation, the patient has regained full use of his penis and is able to achieve a full erection.
In a new case study published in BMJ Case Reports, surgeons from the University Hospitals Birmingham NHS Foundation Trust wrote, “The success of this case therefore should encourage surgeons to attempt penile replantation, even with prolonged ischaemia [inadequate blood supply] time, due to possible success and the potential physical and psychosocial effects of organ loss for the patient.”
Their patient, a 34-year-old man with a known history of paranoid schizophrenia, was brought to surgeons in Birmingham the day after attempting to take his own life, which involved dismembering his own genitalia. He was not discovered for 15 hours, and was immediately rushed to the operating room upon arrival.
There have been only about a hundred penile reattachment surgeries according to medical annals, and they generally occurred within a few hours of detachment. In the past, surgeons would simply sew the penis back onto the body without attempting to reconnect the dorsal nerve and blood vessels, which usually led to scarring in the urethra and desensitization of the penis.
This case sets a new record for the amount of time a penis can be detached from the body before a successful replantation. (The previous record of waiting 18 hours before having an effective surgery was held by the case of a 4-year-old who suffered similar injuries.)
Today, the intricate “microsurgery” requires the re-stitching of nerves and blood vessels that can be smaller than a strand of hair. Urologists and plastic surgeons work together to replace or reconstruct the most viable organ possible — although very few have experience with such delicate procedures.
the new case study, one important nerve that had been severed had retreated back into the body, making it impossible for doctors to access. However, they were able to mend critical blood vessels along the top of the penis with the help of a vascular graft from his arm, and blood flow was returned to the penis.
“Arterial flow was established a further 8 hours after arrival into hospital due to the patient’s concomitant injuries, thus making the total ischaemia time 23 hours,” the report reads.
Schizophrenia and mental disorder are not uncommon among penile amputees, thus making follow-up care imperative yet an exceedingly difficult process. Indeed, without proper care, some patients have been known to re-inflict their injuries, doctors note. Close monitoring, with the help of doctors across many fields, including psychiatry, has been suggested.