A rare complication of circumcision due to monopolar cauterization: Penile necrosis

Abstract

Ayse Ertoy*, Hüseyin Tugrul Tiryaki, Emrah Şenel, Gokhan Demirtas, Derya Yayla and Suleyman Tagci

Penile necrosis due to monopolar cauterization during circumcision is a rare complication and may cause organ loss. When monopolar cauterization applied on an end-organ, current flows through the organ and, causes disruption of blood flow and oxidative stress. Penile injury may include skin, glans and cavernous bodies. Injury can be limited with the help of medical treatment and hyperbaric oxygen treatment, but eventually the need for reconstruction arises. Some case reports of application of feminizing genitoplasty after total organ loss are present on the literature. However, lengthening of penis via dissection of cavernous bodies and application of skin graft seems more appropriate as a method of reconstruction.

At this case report, three-year old male who had penile necrosis after having circumcised at another center will be discussed under the light of current literature. As soon as the patient was hospitalized, medical treatment and hyperbaric oxygen treatment started. However circulation of the necrotic tissue didn’t improve and necrotic part of the penile skin, glans and cavernous bodies were debrided. After the debridement, two centimeters of cavernous body remained. Once tissues recovered, as a second operation, cavernous bodies were dissected through pubic arms and skin graft was applied. As a result, five centimeters of penile body was achieved. Post-operatively no problem was encountered and patient was discharged 23 days after circumcision.