BACKGROUND: Penile amputation is an unusual situation reported globally as isolated cases and small series. It constitutes a urological emergency which requires microsurgical skills for the repair of the penis. We present a case of a penile amputation and discuss the management of this challenging condition.
METHODS: A 47-year-old patient presented to the emergency room with total amputation of corpora cavernosa of the penis resulting from knife aggression. The patient underwent successful microsurgical replantation, demonstrating positive progression and satisfactory results.
UNASSIGNED: Microneurovascular repair of penile amputation is the gold standard. Recommendations include a meticulous anastomosis, and a focus on vein anastomoses for optimal outcomes as well as associating a psychiatric approach. The PENIS score classifies the severity of lesion and predict postoperative complications and main outcomes.
CONCLUSIONS: Penile amputation presents a distinctive challenge, necessitating microsurgical anastomosis, meticulous tissue management, and adherence to established protocols are imperative for effectively managing such intricate cases. Even in cases of posttraumatic partial penile amputation after a long period, can yield satisfactory morphofunctional outcomes.

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BACKGROUND: Fournier's gangrene is necrotizing fasciitis of the genitalia, perineal and perianal region associated with a significant mortality rate. The potentially fatal disease is caused both by aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases is idiopathic or derived from perineal and genital skin infections. Early surgical debridement of necrotic tissues and antibiotics are fundamental.
METHODS: We report a rare case of Fourniers gangrene of a 57-year-old man secondary to circumcision. The patient presented due to painful swelling of the scrotum and perineum associated with high-grade fever. The patient received broad-spectrum antibiotics and underwent immediate surgical debridement; a total of five other debridements were performed during the recovery until the wounds healed. On a second recovery phase, we performed a penile reconstruction with full thickness skin graft with satisfactory cosmetic and functional results.
CONCLUSIONS: FG remains an urgent condition associated with a high mortality rate, requiring immediate treatment. More statistical reports and standard guidelines are necessary to improve the rate of its survival.

Scrotal lymphedema is a rare disease, caused by obstruction of the lymphatic vessels draining into the scrotum, and may be induced by malignant lymphoma. A 27-year-old male, who was treated for Hodgkin\'s lymphoma, presented with scrotal swelling for 3 years. We observed huge scrotal swelling with extension to the suprapubic region and lower right limb, a significantly thickened scrotal wall, and nonpalpable testes. The patient underwent scrotal lymphedema excision followed by surgical scrotal and penile reconstruction. Treatment of scrotal lymphedema is challenging. However, we were satisfied with our surgical result. Our patient experienced both physical and psychological improvements.

BACKGROUND: Traumatic penile amputation is a highly uncommon surgical emergency that requires immediate intervention. Most reported cases involve genital self-mutilation induced by underlying psychiatric disorder, especially schizophrenia. The self-mutilation of external genitals in psychiatric patients, also known as Klingsor syndrome, is a rare form of urotrauma.
METHODS: We present a case of partial penile amputation in a 46-year-old male with Klingsor syndrome admitted to the hospital 3 days after the incident. Urological examination revealed a subtotal cut of the penis, including the distal part of the mons pubis, dorsal and lateral parts of the penile skin, corpus cavernosum, and corpus spongiosum, as well as a partial bulbous urethra rupture. The penis remained suspended by only a thin ventral part of the penile skin. After macroscopic surgical replantation, the patient recovered well and could urinate without any symptoms of urethral stricture. The entire penis remained viable with minimal scarring at the surgical site, and penile erection could be achieved and maintained.
CONCLUSIONS: The case demonstrates a rare instance of the successful proximal penile shaft amputation via macrosurgical techniques by an experienced urologic surgeon.

Penile amputation is a rare deformity mostly resulting from self-mutilation, felonious assault, or accidental trauma, and penile reconstruction or phalloplasty is necessary when microreplantation cannot be performed. Here we report a rare case of a 42-year-old man with traumatic penile amputation and describe surgical techniques for partial penile reconstruction by using a novel innervated and vascularized radial thenar flap free grafting method. Excellent cosmetic and functional results were reported with no severe complications of dysuria, urethral stricture, and urinary fistula were observed during the 23 months of postoperative follow-up time. It is believed that innervated and vascularized radial thenar flap free grafting is an acceptable treatment option for patients with traumatic penile amputation.

Circumcision is regarded as one of the most common procedures in pediatrics. We present a case of a newborn, who has undergone circumcision using monopolar electrocautery. He admitted to the hospital with glans necrosis and was treated with antibiotics and surgical debridement. Four months later, phalloplasty was performed for the newborn using scrotal flap. The result is satisfactory, and the penis is esthetically acceptable with effective urination. Our case suggests the use of scrotal flap for penile reconstruction due to feasibility of procedure and anatomic privilege. It would also support usage of bipolar electrocautery for circumcision to avoid possible unwanted complications of monopolar electrocautery.

BACKGROUND: Penile denudation is a devastating condition often reconstructed with a split-thickness skin graft(STSG). As this kind of reconstruction is challenging, we present an non-invasive treatment using Manuka honey dressings with a satisfying result. This was performed as a salvage procedure after failed STSG.
METHODS: A 55-year-old non-smoking male was admitted from his general practitioner with a newly onset of phimosis and lower urinary tract symptoms. Benign tumours complicated with infection were found on all segments of the penis causing dehiscence of the skin. After surgical removal of tumours and an unsuccessful STSG, Manuka honey dressings was used. Full sexual function was regained, and the patient was satisfied with the result.
CONCLUSIONS: Alternatives to STSG are full-thickness skin graft using the inguinal or scrotal borrowing method, or using a dermal matrix before a STSG. A rediscovered method is using Manuka honey, with its unique combination of bactericidal, anti-inflammatory and healing-promoting properties. A wide range of wound types may benefit from Manuka honey dressings. A recent Danish in vitro study on honey derived from various Danish floras even shows high antibacterial effect superior to commercial medical grade honey. Considering a growing resistance to antibiotics, medical honey may contribute as a alternative to extensive wound care.
CONCLUSIONS: We successfully treated a penile denudation with Manuka honey following a failed STSG. Wounds, ulcers, and burns may be infected, and can be challenging, time consuming, and expensive to treat. Manuka honey may be a good alternative to reconstructive surgery and can be managed on an out-patient basis.

BACKGROUND: Genitalia are linked to self-esteem and male sexual identity, especially among young men, who sometimes require a surgical procedure to acquire more confidence. Among the surgical procedures requested for aesthetical purposes, circumcision is one of the most popular. Although it can be considered to be a simple surgical practice, it may cause severe complications such as penile skin necrosis.
METHODS: We report a case of a catastrophic situation after a circumcision performed on a 27-year-old HIV positive man resulted in a drastic reduction in the length of the penile shaft due to extensive skin loss; this was subsequently restored using dartos-fascio-myo-cutaneous flaps. Primary healing occurred in 10days. No infection, dehiscence or flap ischemia were reported. Donor site morbidity was minimal. An adequate aesthetical appearance and satisfactory functional results were obtained.
CONCLUSIONS: Various techniques are available for penile skin covering, such as skin grafts or cutaneous flaps. The skin of the scrotum seems to be the most suitable tissue to be used to reconstruct the skin covering of the shaft as it is the most similar. Dartos-fascio-myo-cutaneous flap is a single stage procedure that is easy and safe to perform. It can provide satisfactory cosmetic and functional results, offering a large amount of tissue, with minimal donor site morbidity.

Complete penile agenesis (aphallia) is a very rare congenital anomaly. Around 80 cases have been reported to date. Diagnosis of this rare anomaly is made by clinical examination, but treatment options and parental counselling for gender assignment is difficult and challenging for the treating doctor. We report a case of an infant with complete penile agenesis with recto-urethral fistula, who was referred on day 6 of life. This baby developed obstructive uropathy which required vesicostomy. Surgical management consists of gender assignment after discussing in detail the pertinent situation with the parents and accepting their final decision.