Penile Replantation in Severe Polytrauma: A Rare Case With Surgical Insights

Penile amputation is a rare urological emergency that requires prompt surgical intervention to restore both anatomical integrity and functional outcomes. Most reported cases are associated with self-inflicted injury, psychiatric disorders, or sharp trauma, whereas high-energy blunt mechanisms are exceedingly uncommon. We present the case of a 29-year-old male who sustained a motor vehicle accident resulting in traumatic right upper extremity amputation and complete penile transection with testicular exposure. Initial life-saving management was performed within the first two hours after injury, while definitive urologic reconstruction was carried out 72 hours after the trauma, corresponding to an estimated ischemia interval of 72 hours before genital reconstruction. Definitive repair included end-to-end anastomosis of the corpora cavernosa and urethra, with preservation of viable tissue and appropriate urinary diversion. Postoperative imaging demonstrated preserved cavernosal integrity and progressive vascular recovery. At the one-month follow-up, a urethral fistula and right testicular infarction were identified, requiring orchiectomy. Ultimately, after three months, the patient achieved complete urethral healing and recovery of urinary function. This case highlights the feasibility of penile reconstruction in the context of severe polytrauma and underscores the importance of multidisciplinary management, early intervention, and careful postoperative monitoring. Given the absence of standardized guidelines, individualized treatment strategies remain essential to optimize outcomes in these complex injuries.