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
Detalle de evidencia de RCTReferencia del ensayo
Perfil del estudio
- Diseño
- comprehensive review of 46 penile replantation cases across 37 studies (PubMed/EMBASE/Cochrane 2015-2023)
- Tamaño de la muestra (n)
- 46
- Intervención
- Microsurgical penile replantation with various adjuncts including hyperbaric oxygen, laser angiography, leech therapy, PDE inhibitors, and penile splints
- Comparador
- Within-cohort comparisons across innovative management strategies
- Punto final primario
- Postoperative outcomes, complication rates, salvage strategies
- Resultado primario
- 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
- Duración del seguimiento
- Variable across 2015-2023 included studies
- PMID
- 39553533
Hallazgos clave
- 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
Limitaciones
- 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
Implicaciones clínicas
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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