Iatrogenic Amputation of the Distal Third of the Penis During Circumcision: Successful Reimplantation Without Magnification

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Résumé

Background:Traumatic penile amputations, although rare, represent complex urological emergencies. Cases of iatrogenic origin
secondary to circumcision are an exceptionally uncommon but serious etiology. The standard of treatment is microsurgery.
However, in many contexts, particularly in developing countries, access to microsurgery is limited, leading surgical teams to
resort to reimplantation techniques without microvascular anastomosis, with variable results.
Case Presentation:An 8-year-old boy was admitted to our department for complete amputation of the distal third of the penis
during a circumcision. The amputated segment was preserved in saline solution. Emergency reimplantation was performed
within a 3-h timeframe. The procedure included end-to-end urethrorrhaphy over a stent, cavernorrhaphy, and vascular alignment,
all without the use of loupes or an operating microscope. The patient was discharged on the 25th postoperative day with a
perfectly viable reimplanted segment and a satisfactory aesthetic and functional outcome.
Conclusions:This case demonstrates that penile reimplantation can be successful in the absence of microsurgery in children,
through meticulous technique and aggressive postoperative management of edema in settings with limited technological resources.
It also serves as an urgent reminder of the absolute necessity to prevent these tragic accidents through the standardization
and medicalization of circumcision practices. Long-term follow-up is essential to assess the erectile and voiding function of
this patient.

Mots-clés

Penis amputation, reimplantation, Burkina Faso