Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)

Abstract

Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self‑mutilation. Eighty‑seven percent of the self‑mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health‑care team. A 25‑year‑old male patient presented to our emergency department with self‑inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner's warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases.