Klingsor Syndrome—Microvascular Replantation of Penis After Self-Mutilation in Schizophrenia

Abstract

Penile amputation is a rare condition that requires immediate intervention to provide sexual and voiding function. The most common cause is self-mutilation during psychotic attacks and known as Klingsor syndrome. In this study, we present a case of proximal-level total penile amputation of a schizophrenic patient with a review of the literature focusing on long-term results. In this case, the dorsal penile arteries, veins, and nerves were repaired using the standard microsurgical method. There was no perfusion problem in the glans penis or distal penile shaft in the early postoperative period. Skin necrosis developed in the penoscrotal region, which is known to be perfused from the external pudendal artery system. Necrosis was reconstructed with a local flap after debridement. In the long term, no problems that could lead to voiding dysfunction, such as fistula or stricture in the urethra, were observed. At the end of the fourth year, the patient was able to achieve or maintain an erection that would provide sufficient penetration. This study demonstrates the long-term success of microsurgery in a penile amputation case with quantitative Doppler ultrasonography and urodynamic testing results. To avoid skin necrosis problems in pubic-level amputations, we suggest to repair the external pudendal system.