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
Детали доказательств RCTСсылка на исследование
GRADE НизкаяКогортное исследование / серия случаевСостояние: Microsurgical Replantation (Digit / Ear / Scalp) →
Характеристика исследования
- Дизайн
- comprehensive review of 46 penile replantation cases across 37 studies (PubMed/EMBASE/Cochrane 2015-2023)
- Размер выборки (n)
- 46
- Вмешательство
- Microsurgical penile replantation with various adjuncts including hyperbaric oxygen, laser angiography, leech therapy, PDE inhibitors, and penile splints
- Компаратор
- Within-cohort comparisons across innovative management strategies
- Первичная конечная точка
- Postoperative outcomes, complication rates, salvage strategies
- Основной результат
- 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
- Длительность наблюдения
- Variable across 2015-2023 included studies
- PMID
- 39553533
Ключевые выводы
- 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
Ограничения
- 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
Клиническое значение
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.
Связанные исследования
Successful Microsurgical Replantation of Amputated Penis: A Case Report and Review of Literature
Akhoondinasab MR, Farahmand HR, Zahedi A, Saraee A (2023)
Complete penile amputation during ritual neonatal circumcision and successful replantation using postoperative leech therapy
Banihani OI, Fox JA, Gander BH, Grunwaldt LJ, Cannon GM (2014)
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)
Medicinal Leech Therapy in Urology: A PRISMA-Compliant Systematic Review
Battin AO, Hobeika N, Zdilla MJ (2023)