What is the term for a mutilated head of the penis?

Terminology for Mutilated Head of Penis

The medical term for a mutilated head of the penis is "traumatic penile amputation" or "traumatic glans amputation," depending on the extent of injury.

Classification and Terminology

The terminology used to describe penile mutilation depends on the extent and nature of the injury:

• Complete amputation: When the entire penis is severed
• Partial amputation: When a portion of the penis is severed
• Glans amputation: Specifically when the head (glans) of the penis is severed
• Penile shaft sub-amputation: When the skin of the shaft is removed but deeper structures remain 1
• Glanular mutilation: When the glans is damaged but not completely removed 2

Management Approach

The American Urological Association guidelines provide clear direction for managing penile injuries based on the extent of trauma 3:

Immediate Management

1. For traumatic penile amputation:

   • Prompt penile replantation should be performed when the amputated appendage is available
   • The amputated part should be wrapped in saline-soaked gauze, placed in a plastic bag, and then placed on ice during transport
   • This two-bag system preserves tissue viability 3

2. For extensive genital skin loss or injury:

   • Perform exploration and limited debridement of non-viable tissue
   • Genital skin is well-vascularized and tissues with marginal viability may survive due to collateral blood flow 3

Surgical Approach

1. For complete/partial amputation with available tissue:

   • Re-anastomosis of macroscopic structures including corpora cavernosa
   • Spatulated repair of the urethra and skin
   • Microvascular surgeon consultation for microscopic repair of dorsal arteries, veins, and nerves 3

2. For glanular mutilation with remaining tissue:

   • Glans reconfiguration can be performed where deformed glanular tissue remnants are mobilized, flattened into sheets, and configured to redrape the summit of the penis 2

3. For extensive skin loss:

   • Reconstructive techniques include primary closure, advancement flaps, skin grafts, free tissue flaps, and pedicle-based skin flaps 3
   • Scrotal Dartos-Fascio-Myo-Cutaneous flaps have shown satisfactory results for penile shaft skin reconstruction 1

Outcomes and Complications

Successful management of penile mutilation focuses on:

1. Functional outcomes:

   • Preservation of urinary function
   • Restoration of sexual function
   • Return of sensation 4, 5

2. Cosmetic outcomes:

   • Acceptable appearance
   • Psychological acceptance 5

3. Common complications:

   • Urethral stricture
   • Fistula formation
   • Distal necrosis
   • Erectile dysfunction
   • Sensory loss 4

Important Considerations

• Microreplantation procedures have uniformly good results with minimal post-operative complications 5
• When microreplantation cannot be performed, older corporal reattachment techniques may be offered 5
• For cases requiring complete phallic reconstruction, microsurgical free forearm flap phalloplasty may restore acceptable cosmetic and functional results 5
• Early intervention is critical to prevent permanent erectile dysfunction 6
• Regular follow-up is necessary to monitor for complications such as erectile dysfunction, penile curvature, or urethral stricture 6

Specialized Cases

For penile intraepithelial neoplasia (PIN) with mutilation:

• Circumcision is an essential component of management
• Early biopsy is indicated to establish diagnosis before treatment 3
• Treatment options include surgical excision, Mohs micrographic surgery, radiotherapy, or topical treatments depending on extent 3