Leeches and Caudal Analgesia After Replantation for Glans Amputation During Neonatal Circumcision
Mousa A, Keefe DT, Wong K, Davidge K, Lorenzo AJ, Dos Santos J (2022) · Urology · n=1
RCT evidence detailTrial reference
Study Profile
- Design
- single-patient case report (28-day-old neonate, Hospital for Sick Children, Toronto)
- Sample size (n)
- 1
- Intervention
- Microvascular replantation of complete penile midshaft amputation with postoperative leech therapy, topical heparin, and caudal analgesia
- Comparator
- No control - case report
- Primary endpoint
- Penile survival, replantation success, neonatal pain control
- Primary result
- Successful microvascular replantation with multimodal postoperative management; leech therapy combined with topical heparin and caudal analgesia for neonatal pain control
- Follow-up duration
- Postoperative hospitalization with outpatient follow-up
- PMID
- 35263644
Key Findings
- Successful penile midshaft replantation in 28-day-old neonate
- Combined leech therapy + topical heparin + caudal analgesia protocol
- Multimodal anticoagulant strategy
- Pain control optimized for neonatal tolerability
- Builds on Banihani 2014 (7-day-old penopubic replant)
Limitations
- Single case - no generalizable conclusions
- Cannot attribute success to specific component of multimodal protocol
- Limited long-term functional follow-up
- Selection bias toward salvageable cases
- Subjective pain assessment in neonate
Clinical Implications
Mousa 2022 advances neonatal penile replantation by integrating caudal analgesia for pain control alongside leech therapy and topical heparin. For US clinicians under K040187, the case illustrates how leech therapy fits into broader perioperative protocols for pediatric replantation. The multimodal approach is consistent with contemporary regional anesthesia practice in pediatrics.
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