Trauma of the external genitalia in children: amputation of the penis and emasculation.

PURPOSE

Amputation of the penis or emasculation in children is rarely reported in the medical literature. This study involves 7 children with these injuries admitted to the University Hospital San Vicente de Paul, Medellin, Colombia, from 1960 to 1995. A new surgical technique is described for penile reconstruction that makes sex reassignment to the female gender unnecessary in most if not all cases.

MATERIALS AND METHODS

Clinical histories and photographs of 7 boys 4 months to 8 years old with penile amputation or emasculation were reviewed. Five patients were younger than 1 year. Sex reassignment to the female gender was accepted by 1 family and refused by 4. Three boys were hospitalized at ages 3.5, 4 and 4.5 years, respectively, and underwent phalloplasty using the stumps of the remaining corpora cavernosa. The 2 older patients had been emasculated in accidents. In the 8-year-old patient the penis was reattached and the 7-year-old boy awaits myodermal flap phalloplasty.

RESULTS

The boy raised in the female gender requested reassignment as a boy 14 years later. The 3 patients who underwent penile reconstruction were followed for 17, 12 and 8 years, respectively. At the last followup they emptied the bladder, and had normal skin sensitivity and erections. After 3 years the boy with a reattached penis has no problem emptying the bladder but he has lymphedema and decreased skin sensitivity.

CONCLUSIONS

Phalloplasty using the remaining stumps of the corpora cavernosa should be first line therapy in children with traumatic loss of the penis. It restore the functional and cosmetic aspects of the organ, and makes sex reassignment to the female gender unnecessary. Replantation of the penis must be attempted when the amputated organ is recovered. A microvascular technique is recommended.