Penile Replantation: A Review of Microsurgical Techniques, Patient Outcomes, and Solutions to Complex Reconstructive Challenges
Arbel EJ, Reese AD, Richards R, Singh S, O'Shea AW, Hennig F, Abramowitz D (2024) · Plastic Surgery (Oakville) · n=46
RCT evidence detailTrial reference
Study Profile
- Design
- comprehensive review of 46 penile replantation cases across 37 studies (PubMed/EMBASE/Cochrane 2015-2023)
- Sample size (n)
- 46
- Intervention
- Microsurgical penile replantation with various adjuncts including hyperbaric oxygen, laser angiography, leech therapy, PDE inhibitors, and penile splints
- Comparator
- Within-cohort comparisons across innovative management strategies
- Primary endpoint
- Postoperative outcomes, complication rates, salvage strategies
- Primary result
- Postoperative necrosis in 56.5% (26/46) of cases; scrotal hematoma in 3 cases; psychiatric comorbidity in 23/46; common adjuncts include hyperbaric O2, laser angiography, leech therapy, PDE inhibitors, and penile splints
- Follow-up duration
- Variable across 2015-2023 included studies
- PMID
- 39553533
Key Findings
- 46 cases across 37 studies (2015-2023 window)
- 56.5% postoperative necrosis rate - dominant complication
- Psychiatric comorbidity in 50% of cases
- Leech therapy named among innovative adjunct strategies
- Need for standardized protocols emphasized
Limitations
- Review of heterogeneous case reports
- Cannot establish causality of any specific intervention
- Publication bias toward successful cases
- Variable outcome reporting across included studies
- Limited long-term functional follow-up
Clinical Implications
Arbel 2024 contextualizes leech therapy as one of several innovative adjuncts in penile microsurgical replantation. For US clinicians under K040187, the review reinforces leech utility for venous congestion in a population where 56.5% experience postoperative necrosis. The systematic nature provides epidemiological framing for individual case decisions in this rare urologic emergency.
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