Traumatic amputation of the glans penis: Report of a case
ANTHONY J. CERONE, JR., D.O. JEROME R. PIETRAS, n.o. Stratford, New Jersey F. KENNETH SHOCKLEY, DD., FACOS Cherry Hill, New Jersey
urologist recognize the need for these supportive Traumatic amputation of the glans discussions. In most cases, adequate sexual func- penis is an unusual injury which has tion on both a physiologic and psychologic basis occasionally been reported in the can be restored. A case of traumatic penile ampu- literature. Usually, the amputation is tation is reported in this article. The amputation the result of an accident; however, it occurred while the patient was masturbating with can be the result of unusual sexual the aid of a hand-held vacuum cleaner. While this behavior. In the case reported, the practice has become more common in recent years, patient was masturbating with a most accounts in the literature on this subject are hand-held vacuum cleaner. presented in a "letters-to-the-editor" section. Practicing urologists should be aware of this traumatic type of injury Report of case and its consequences. The following A 19-year-old white male presented to the hospital fol- operative approaches should be lowing a traumatic injury to the penis. One hour prior to considered: reanastomosis, plastic admission, the patient was engaged in masturbation. In reconstruction, or local reshaping. In search of further excitement during this activity, he uti- the case presented, reshaping was lized a hand-held vacuum cleaner. The patient claimed he learned about this so-called enhancer from advertis- utilized since only the distal glans ing in a pornographic magazine. He sustained an ampu- was amputated and the actual tation to the glans penis because the vacuum cleaner amputated segment was extremely contained a rotating fan behind the opening of the hol- lacerated and contaminated. The low suctioning tube. Despite a moderate loss of blood, patient was left with an adequate the patient s vital signs were stable on his arrival at the amount of penile shaft. Optimal emergency room. Examination of the genital area, surgical results with minimal which had been packed with towels for compression he- psychiatric sequels can be mostasis, revealed a complete amputation of the glans anticipated if the best operative penis and total maceration of the distal-most tissues procedure is selected and the need (Fig. 1). Bleeding was considerable. The distal-most por- for early, postoperative, psychiatric tion of the severed urethra was not easily identified. The length of the penile shaft was approximately 7 cm. A counseling is recognized. number of minor abrasions could be observed on the skin of the shaft. The testicles were normal on palpation and there was no ecchymosis or edema of the scrotal skin. Rectal examination revealed a normal prostate. The vacuum cleaner was also brought into the emergency room for inspection. The avulsed glans penis was re- Traumatic amputation of the glans penis is a dev- trieved from the device. The tissue was nonviable be- astating urologic emergency requiring prompt cause of the degree of contamination and maceration. evaluation and competent management. Each case Laboratory admission tests and x-rays were all within should be handled individually and the urologist normal limits. The patient s hemoglobin was initially must decide whether the primary treatment 15.1 gm./100 ml. After equilibration without transfu- sion, his hemoglobin was 14 gm./100 ml. should be either reanastomosis, plastic reconstruc- The patient readily volunteered all of the above infor- tion, or local reshaping. mation on his injury without demonstrating any embar- Following prompt operative management, the rassment or reservations. After the physical examina- individual involved should undergo early counsel- tion was conducted, the dressings were again removed ing with a psychiatrist. It is imperative that the and the distal end of the penis was copiously lavaged