MP02-07 REVISED PENIS SCORING CRITERIA: A MULTILINGUAL SYSTEMATIC REVIEW OF PENILE AMPUTATION AND REPLANTATION
Abstract
INTRODUCTION AND OBJECTIVE:
Penile amputation can cause severe physical and psychosocial distress and, if feasible, warrants prompt replantation. Since the advent of microsurgery, its superiority over surgical repair for penile replantation has been presumed. However, this has been difficult to verify given the paucity of penile amputation publications compounded with inconsistent thorough reporting. The purpose of this study was to produce an updated systematic review of penile replantation, substantiated by the largest sample size to date, and to appraise the comparative value of the novel PENIS Score.
METHODS:
A systematic review identified 122 microsurgical and 40 surgical cases of penile replantation that qualified for review. The novel PENIS Score, which was modified to increase its utility and reproducibility, stratified penile amputations based on five criteria: position along the shaft, extension through the penis, neurovascular repair, ischemia time/type, and severed edge condition/contamination. Each individual PENIS criteria was then evaluated for association with short-term postoperative complications as well as erection, urination, and sensation.
RESULTS:
The viability of microsurgical and surgical replantation was equivalent at 92% and 94%, respectively. A statistically significant correlation was found between microsurgical repair and the return of sensation, though this did not correlate with nerve repair. While the return of sensation with nerve repair was 51%, comparable to microsurgical replantation without nerve repair at 42%, both were significantly higher than the 14% found in surgical replantation. There was a significant correlation noted between the extension of the amputation and severity of postoperative complications in microsurgical replantations (τ=.2649, p=.0126) not observed with surgical replantation. Preservation of a skin bridge was associated with a 40% reduction in severe postoperative complications, regardless of surgical method.
CONCLUSIONS:
Microsurgical replantation is superior in the return of sensation, with or without nerve repair. When faced with a situation in which no microsurgical expertise is available, surgical replantation is an appropriate alternative. Implementing the PENIS Score will help guide future case reports and systematic reviews.
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Source of Funding:
None
