{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:54:33Z","timestamp":1774439673092,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.23775.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T00:00:00Z","timestamp":1600732800000}}],"reference-count":19,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T00:00:00Z","timestamp":1600732800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"\n Background:<\/ns4:bold>\n Penile amputation is an emergency urologic condition requiring immediate attention in order to maximize functional outcomes. Unfortunately, there is limited experience and publication of case reports describing the successful replantation of penis after incomplete amputation, especially in facilities without adequate microsurgical tools and means. We hereby present a case of penile amputation caused by a mechanical grass cutter and a discussion of its surgical management.\n <\/ns4:p>\n \n Case description:<\/ns4:bold>\n A 33-year-old Indonesian male presented to the emergency department with incomplete penile amputation six hours post injury. The patient has no prior medical history and presented with penile amputation due to a mechanical grass cutter trauma. He underwent immediate non-microsurgery\u00a0reconstructive replantation of the penis, reattaching all visible vascular, corporal, and fascia layers. After replantation, the patient recovered well and showed preserved normal appearance and sensitivity of the penis. Subsequent Doppler ultrasound investigation revealed adequate arterial flow at the distal end of the anastomosis. The patient was discharged five days after surgery.\u00a0\n <\/ns4:p>\n \n Conclusion:<\/ns4:bold>\n In the absence of microsurgical tools and means, the use of non-microsurgical replantation with an at least 2.5x loupe magnification should be the choice of treatment in the case of incomplete penile amputation. The technique showed good outcomes involving adequate functional and cosmetic restoration.\n <\/ns4:p>","DOI":"10.12688\/f1000research.23775.2","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T07:50:06Z","timestamp":1600761006000},"page":"681","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Non-microscopic surgical management of incomplete penile amputation"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2894-827X","authenticated-orcid":false,"given":"Donny Eka","family":"Putra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3075-835X","authenticated-orcid":false,"given":"Theddyon Bhenlie Apry","family":"Kusbin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paksi","family":"Satyagraha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5783-5509","authenticated-orcid":false,"given":"Stephanie Taneysa","family":"Widodo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2020,9,22]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1000210","DOI":"10.4172\/2167-1222.1000210","article-title":"Traumatic Penile Amputation: A Case Report and Acute Management.","volume":"3","author":"M Patel","year":"2014","journal-title":"J Trauma Treat."},{"key":"ref-2","first-page":"143-146","article-title":"Penile replantation.","volume":"46","author":"K Krishnakumar","year":"2013","journal-title":"Indian J Plast Surg."},{"key":"ref-3","doi-asserted-by":"crossref","first-page":"276-80","DOI":"10.1097\/00006534-197759020-00023","article-title":"Successful clinical replantation of an amputated penis by microneurovascular repair.","volume":"59","author":"B Cohen","year":"1977","journal-title":"Plast Reconstr Surg."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"287-91","DOI":"10.1097\/00006534-197708000-00028","article-title":"Microsurgical replantation of a completely amputated penis and scrotum: Case report.","volume":"60","author":"S Tamai","year":"1977","journal-title":"Plast Reconstr Surg."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"227-232","DOI":"10.1055\/s-0036-1597567","article-title":"Penile Replantation: A Retrospective Analysis of Outcomes and Complications.","volume":"33","author":"S Morrison","year":"2017","journal-title":"J Reconstr Microsurg."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"S78-S84","DOI":"10.21037\/tau.2018.11.11","article-title":"Two cases of successful microsurgical penile replantation with ischemia time exceeding 10 hours and literature review.","volume":"8","author":"X Liu","year":"2019","journal-title":"Transl Androl Urol."},{"key":"ref-7","article-title":"EAU Guidelines on Urological Trauma 2020. European Association of Urology Guidelines 2020 Edition [Internet].","author":"N Kitrey","year":"2020"},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"375285","DOI":"10.1155\/2014\/375285","article-title":"Traumatic Penile Injury: From Circumcision Injury to Penile Amputation.","volume":"2014","author":"J Kim","year":"2014","journal-title":"Biomed Res Int."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/1752-1947-8-125","article-title":"Successful replantation of an amputated penis: A case report and review of the literature.","volume":"8","author":"O Riyach","year":"2014","journal-title":"J Med Case Rep."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"1582047","DOI":"10.1016\/S0022-5347(17)73098-4","article-title":"Two Unusual Penile Injuries.","volume":"2019","author":"W Ehrich","year":"1929","journal-title":"J Urol."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"49-53","DOI":"10.1002\/sm2.54","article-title":"Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature.","volume":"3","author":"O Raheem","year":"2015","journal-title":"Sex Med."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"317-21","DOI":"10.1097\/00000637-198304000-00011","article-title":"Microsurgical replantation of a completely amputated penis.","volume":"10","author":"F Wei","year":"1983","journal-title":"Ann Plast Surg."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"147-149","DOI":"10.4111\/kju.2011.52.2.147","article-title":"Amputation of glans penis: A rare circumcision complication and successful management with primary anastomosis and hyperbaric oxygen therapy.","volume":"52","author":"G Faydaci","year":"2011","journal-title":"Korean J Urol."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"192-5","DOI":"10.1016\/j.juro.2008.03.041","article-title":"Penetrating External Genital Trauma: A 30-Year Single Institution Experience.","volume":"180","author":"S Phonsombat","year":"2008","journal-title":"J Urol."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"981-3","DOI":"10.1016\/j.urology.2004.01.019","article-title":"Leech therapy in penile replantation: A case of recurrent penile self-amputation.","volume":"63","author":"M Mineo","year":"2004","journal-title":"Urology."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"1602-9","DOI":"10.1007\/s00268-001-0157-6","article-title":"Management of penile amputation injuries.","volume":"25","author":"J Jezior","year":"2001","journal-title":"World J Surg."},{"key":"ref-17","first-page":"179-82","article-title":"Penile fracture: Long-term outcome of treatment.","volume":"85","author":"W Kochakarn","year":"2002","journal-title":"J Med Assoc Thail."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"981-5","DOI":"10.1016\/s0022-5347(17)61188-1","article-title":"Self-emasculation.","volume":"107","author":"R Mendez","year":"1972","journal-title":"J Urol."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"253-257","DOI":"10.1016\/j.afju.2017.02.003","article-title":"Successful penile reimplantation and systematic review of world literature.","volume":"23","author":"J Mensah","year":"2017","journal-title":"African J Urol."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/9-681\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/9-681\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/9-681\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,21]],"date-time":"2020-10-21T10:30:11Z","timestamp":1603276211000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/9-681\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,22]]},"references-count":19,"URL":"https:\/\/doi.org\/10.12688\/f1000research.23775.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.29017.r71791","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.29017.r71791","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,22]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/9-681\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.26235.r66594, Omer A. Raheem, Department of Urology, Tulane University, New Orleans, LA, USA, 16 Jul 2020, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/9-681\/v1#referee-response-66594","order":0,"name":"referee-response-66594","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Donny Eka Putra<\/b>; \nPosted: 28 Jul 2020<\/i>; 1. Thank you prof Raheem, we highly appreciate your feedback. We are deeply sorry for the delay in our respond. 2. Need to delineate and describe anatomical injury and orientation: ventral and dorsal? What is preop trauma\/injury assessment and how it was managed at the emergency room level? The injury sustained resulted from a grass-cutter blade in the direction from the dorsal side of the penis. The injury consisted of dorsal artery nerves and veins, bilateral corpus cavernosum, and corpus spongiosum. The urethra was intact.Pre-operation assessment in the emergency department was limited to penile amputation only, as we were unable to clearly define structural damages due to diffuse bleeding and excessive pain. At the time of patient arrival, trauma resuscitation protocol including airway, breathing, and circulation assessment was running. The patient was also given antibiotic anti-tetanus, blood specimen testing and on a 23G IV line to handle the earliest signs of shock if necessary.The patient was then treated with compression bandage on the penis to minimize bleeding.3. I understand microscopy was not available but it remains gold standard in penile injury repair and reconstruction especially when anatomizing penile vasculature and corporal tissues and urethral. However, surgical loops were used? Correct?  Yes, we used surgical loupe with 2.5x magnification.4.    How was urethral managed? Did you do preop UA, intra op cysto? Passing catheter? Any resistance? Did you repair urethra? At the time of surgical exploration, urethra was found to be intact and the catheter was able to pass through without any resistance.  I did not do prep UA and i did not have the need to repair the urethra. 5. Describe in detail penile vascular injury? Was dorsal penile arteries, veins, and nerves all injures? Did you use intrap doppler to assess for arterial signals?     Surgical exploration revealed dorsal penile veins and nerves injury along with corporal bodies. I did not use doppler US because it was not available during surgery.6. Why it was not repaired? You also mentioned deep penile artery was not repaired? What I meant by \u2018not repaired\u2019 is that I did not repair it by micro-surgical means to create a proper end-to-end anastomosis. I however did an anastomoses by approximating the deep dorsal artery end with the available 2.5x loupe magnification.7. What is post op follow up? How many days? Months since the injury? Do you have SHIM or AUA SS assessed? Did he retain any erectile or ejaculatory function? Make clear in the paper?The patient was discharged from the hospital on the 5th day after surgery. At day 5, the patient underwent doppler ultrasound to assess vascularization of penile distal to the injury. The patient was discharged without catheter following no difficulty in voiding. At one month after surgery, the patient was evaluated with IPSS,  IIEF, and EHS score. Yes, the patient retained erection and ejaculation function at the level of grade 3 EHS, IIEF score 19, IPSS score 2, QOL 1.8. Were other specialities like plastics present to assist or only urology?No, Only Urology.9. What is the management of foley cath post op and wound care? On the 3rd day after surgery we applied a new sterile dressing on the wound and observed no significant edema or pus or any leakage. On the fifth day after surgery, we adopted a post operative open wound treatment care plan. The catheter was also removed at the 5th day post surgery with close observation for hematuria or urinary retention. 10.    Describe reconstruction sutures used and what fashion interrupted vs continuous? I used vicryl 5\/0 interrupted suture on the corporal bodies and 4\/0 vicryl interrupted suture on fascia and skin.11. In your conclusion, you mentioned that microscopic repair remains gold standard; however, if there are limited resources, then non micro repair is possible. That\u2019s ok. However you used surgical loops? Correct?  Yes. My apologies, i will revise my conclusion with the recommendation of doing repair with at least a 2,5x surgical loupe like the way i treated the patient in the paper. 12. Happy to write a short editorial to accompany this paper after revision is made.Thank you, we highly appreciate the time you spent to review our paper. We would love to have your short editorial to accompany our paper.","URL":"https:\/\/f1000research.com\/articles\/9-681\/v2#referee-comment-5776","order":1,"name":"referee-comment-5776","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.29017.r71791, David J. Ralph, Andrology Department, University College London Hospital, London, UK, 07 Oct 2020, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/9-681\/v2#referee-response-71791","order":2,"name":"referee-response-71791","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Donny Eka Putra<\/b>; \nPosted: 12 Oct 2020<\/i>; Dear Professor David J Ralph,Thank you for your review and comments on this article.I am very appreciative of your expertise in this kind of case. Stay safe and healthy","URL":"https:\/\/f1000research.com\/articles\/9-681\/v2#referee-comment-6030","order":3,"name":"referee-comment-6030","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}