Penile replantation after self-inflicted amputation.

In 4 men with self-inflicted penile amputation, replantation was successful using microsurgical technique. Postoperative complications were minimal. In 1 man who had amputated his penis and then amputated his scrotum and testicles, a small skin graft was necessary to close a portion of the defect. A mild urethral stricture that developed in this man responded to dilation. Return of sensation was excellent. Normal erections were reported by all men. Microsurgical replantation is the treatment of choice for this injury and is superior to other techniques of penile reattachment, which have a high incidence of distal necrosis, fistula and stricture formation, as well as incomplete or absent sensation and compromised erectile function. Of concern in this group of men is the high incidence of previous or subsequent penile mutilation. Two of the 4 men have a history of recurrent self-mutilation. The follow-up in this series is longer than previously reported and the overall psychiatric pathology appears to be quite severe and persistent.