Penis repair after mutilation

In the midst of divorce proceedings triggered, perhaps, by “inappropriate relationships” on his part, Catherine Kieu Becker drugged her husband’s meal to render him unconscious, tied him to a bed and cut off his penis with a 10-inch kitchen knife, police say. She then put the severed organ in the garbage disposal and turned it on before calling 911.

Surprisingly, penis destruction is not that uncommon an event, and surgeons have developed a variety of techniques to deal with it.

Most news stories about the incident cite the case of Lorena Bobbitt, who cut off the penis of her husband, John, and threw it out of a moving car. That penis was ultimately found and reattached, leading John Bobbitt to a brief career in porn movies. But a cursory search of the Internet suggests that the event is far more common than might be expected.

One of the oldest tales of penile rage involves Osiris, the Egyptian god of the afterlife and the underworld, and his sister/wife Isis, goddess of motherhood and magic. Their brother Set, god of chaos, was jealous of the relationship and killed Osiris, cutting him into 14 pieces that he scattered across Egypt. Isis was able to collect and reassemble 13 of the pieces, but could not find the penis, which had been eaten by a fish. To replace it, she fashioned one out of gold before bringing him back to life. Using the new phallus, the couple conceived Horus, the god of the sky and vengeance.

More recently (1916), Russian revolutionaries lured the monk Grigori Rasputin, confidant of Czarina Alexandra, from his hiding place, poisoned him, shot him, beat him, cut off his penis, tied him up and threw him into an icy river. The penis is claimed to be in a museum of erotica in St. Petersburg.

In 2005, Kim Tran, a 35-year-old woman in Anchorage, Alaska, cut the penis off her 44-year-old boyfriend and attempted to flush it down the toilet. She was angry because he would not leave her aunt, to whom he was married. Utility workers recovered the penis, which was successfully reattached.

Several news reports indicate that Thailand may lead the world in penis slashings, often over disputes about the common custom of men having a second wife. The act is colloquially referred to as “feeding the ducks” because that is apparently a common way of getting rid of the evidence. A 2008 report in the journal Burns indicated that electrical burns are a common cause of penis loss in India, although the report did not address how the injuries occur.

A variety of techniques are available for repair and replacement. If the penis is intact it can be reconnected — though the surgery is time-consuming and delicate. The first successful case was reported in 1977, involving a mentally disturbed 21-year-old man who cut his organ off with a straight razor because he was obsessed with guilt over his sexual behavior. Surgeons at Massachusetts General Hospital successfully reattached it, restoring full function.

Penile amputation

Penile amputation involves the complete or partial severing of the penis. A complete transection comprises severing of both corpora cavernosa and the urethra. Amputation of the penis may be accidental but is often self-inflicted, especially during psychotic episodes in individuals who are mentally ill.

Penetrating injury

Penetrating injury is the result of ballistic weapons, shrapnel, or stab injuries to the penis. Penetrating injuries are most commonly seen in wartime conflicts and are less common in civilian medicine. Penetrating injuries can involve one or both corpora, the urethra, or penile soft tissue alone.

Penile soft tissue injury

Penile soft tissue injury can result through multiple mechanisms, including infection, burns, human or animal bites, and degloving injuries that involve machinery. The corpora, by definition, are not involved.

Perhaps the most common injury to the penis occurs during sexual activity. In the flaccid state, injury to the penis is rare because of the mobility and flexibility of the organ. During an erection, arterial blood flow causes the penis to be come rigid thus placing it at higher risk for injury. Although there is no bone in the penis, urologists frequently refer to the injury as a penile “fracture.” During vigorous thrusting, the erect penis may accidentally slip out of the vagina. Due to the fast action, the penis strikes the outside of the woman instead of being reinserted into the vagina. The penis may then bend sharply despite the erection. A typical sign of this problem is a sharp pain in the penis joined by a “popping” sound. The pain and sound are produced by a rupture of the tunica albuginea, which is stretched tightly during the time of an erection. The pain may last for a short time or it may continue. The penis develops a collection of blood under the skin called a hematoma, which can distort the appearance of the penis (eggplant deformity). The injury is usually limited to one or both of the corpora cavernosa and, on rare occasions, the urethra.

The penis can also be injured by tearing the suspensory ligament, the structure that supports the organ at its base. Attached to the pelvic bone, this ligament can rip if an erect penis is pushed down suddenly causing pain and bleeding.

Further injuries can occur if a man places a rubber tube or other instrument around the base of the penis that is too tight or on for too long. Cutting off the blood supply, it can produce a wound known as a strangulation lesion. Also, if an object is inserted into the urethra, both it and/or the penis can be injured.

How are injuries to the penis treated?

If a person sustains a penile injury, a urologist will take a thorough medical history and complete a physical examination along with blood and urine tests. The focus of any initial examination is to define the injury and assess the damage to the penis. Given that information, the doctor may call for other tests including a retrograde urethrogram if he/she thinks the urethra is involved. This test is performed by injecting a liquid radio contrast solution through the opening at the top of the penis and then taking X-rays. If the X-ray shows any leakage outside the urethra, it may indicate damage to that part of the urinary tract.

Additional imaging techniques might include an ultrasound of the penis, MRI or a special test called a cavernosogram. In the latter test, a thin hypodermic needle is inserted into one area of the penis before a radio contrast solution is injected and X-rays taken.

If the injury is amputation of the penis, the amputated portion should be wrapped in gauze soaked in sterile saline solution and placed in a plastic bag. The plastic bag should then be put into a second bag or cooler with an ice water slush. If reattachment of the penis is possible, the lower temperature produced by the slush will increase the likelihood of successful reattachment. Penile reattachment even after 16 hours has been reported to be successful.

Historically, treatment for a penis fractured during sexual activity was non-surgical management (e.g., cold compresses, pressure dressings, penile splinting and anti-inflammatory medications). Today, the treatment of choice will probably be for the individual to undergo surgery since it has the best long-term results by lowering complication rates often linked to non-surgical approaches. The most common surgical technique is to “deglove” the penis by making a cut around the shaft near the glans (glands) penis and peeling back the skin to the base to examine the inner surface. The surgeon will then evacuate any hematoma that helps to make examination of any tears in the tunica albuginea easier. If tears exist, they are repaired before the skin is sewn back into position.  A Foley catheter may be placed through the penile urethra into the bladder to drain urine and allow the penis to heal. With the entire penis bandaged, the patient will probably remain in the hospital for one or two days, and go home with or without the catheter. They may be given antibiotics and pain medication and will probably be asked to make a followup office visit with their doctor.

For massive injuries to the penis, major reconstruction is frequently possible by urologists experienced with this difficult surgery.  How closely the reconstructed penis can return to normal urinary or sexual function varies greatly.

What can be expected after treatment for injuries to the penis?

Most cases of fractured penis caused by sexual activity and most other minor penile injuries will heal without problems. However, complications can and do occur. Possible complications include: infection, erectile dysfunction due to blockage of the nerve or blood supply to the penis, priapism in which the penis becomes erect and stays erect to the point of pain, fistula formation in which urine may leak out of the urethra and through the skin of the penis to the outside, curvature (chordee) of the penis after the injury has healed or major loss of skin, portion of the urethra or corpora cavernosum. Failure for the return of sufficient sexual function is dependent upon the degree of injury to the arteries, nerves and corpora cavernosum and whether the patient was experiencing erectile dysfunction just prior to the injury.

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