# Clinical sources for the penile replantation atlas

Status: source record for an educational review model. Clinical interpretation and independent citation review remain open.
Retrieved: 2026-09-22.
Question: Which current society guidance and primary reports support the requested eight teaching stages, without implying one universal operative sequence or equating tissue survival with functional recovery?
Scope: constructed complete shaft amputation with the segment available. Published case material supplies evidence only. No patient photographs were retrieved or copied.

## Retrieval record

This source review used official EAU/AUA pages, PubMed/PMC records, and Europe PMC text. Four search rounds: (1) current guidelines and operative reports; (2) counter-position, congestion, and function despite survival; (3) AUA version and direct statement verification; (4) primary report metadata and accessible text. Coverage met for a draft storyboard with three primary reports read in full. Full AUA 2020 text remains an explicit retrieval gap. No saturation claim is made for the wider literature.


## Source inventory

### G1. EAU guideline, opened full text

European Association of Urology. EAU Guidelines on Urological Trauma, 2026 edition. Guideline office: Arnhem, the Netherlands. Relevant locations: section 4.5.4.d.2, penile avulsion injuries and amputation; section 4.5.6, follow-up.

- [Guideline chapter](https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines)
- [Edition and citation information](https://uroweb.org/guidelines/urological-trauma/chapter/citation-information)
- DOI/PMID: not supplied on the opened guideline pages; identifier confirmation not applicable.
- Retrieval: relevant full-text sections and edition page read.
- Anchored excerpt, section 4.5.4.d.2: “The penis must not come into direct contact with the ice.”
- Extracted support: resuscitation; assessment of the recovered segment; sterile saline and saline-moistened gauze inside a bag cooled by iced water; microsurgical reconstruction preferred; reconstruction includes corporal, urethral, dorsal vascular, and neural structures; layered coverage and urinary drainage. The guideline says cavernosal arteries are generally too small to anastomose. Genital-trauma follow-up includes urinary and erectile complications and psychological support.
- Stage mapping: 3, 4, 5, 6, 7, 8.
- Boundary: this is society guidance, not a comparative primary study. Its time cutoff is intentionally excluded from prototype teaching text pending Lee's review.

### G2. AUA Urotrauma guideline, current version verified; direct full text unresolved

American Urological Association. Urotrauma Guideline, published 2014, amended 2017 and 2020. Statement 32 and its discussion are relevant; statement 33 concerns counseling.

- [Official guideline PDF](https://www.auanet.org/Documents/education/clinical-guidance/Urotrauma.pdf)
- [AUA current guideline catalogue](https://helpdesk.auanet.org/hc/en-us/articles/40948838469143-Guidelines)
- DOI/PMID: not asserted for this institutional guideline.
- Retrieval: current official catalogue opened; confirms the 2020 amendment as the listed version. The indexed official PDF returned statement text in search. Direct PDF requests returned errors/403, so the full guideline was not read.
- Indexed excerpt, statement 32: “Surgeons should perform prompt penile replantation in patients with traumatic penile amputation”.
- Indexed support, not yet admitted as independently opened full text: saline-moistened gauze, a two-bag cooling system, repair of macroscopic structures, and microsurgical consultation for dorsal arteries, veins, and nerves. Mark this source as awaiting direct text review; G1 independently supports the preservation and reconstruction concepts.
- Stage mapping: candidate support for 3, 5, 6, 8.
- Status: full-text confirmation pending. Do not label this row fully reviewed.

### P1. Krishnakumar and colleagues, primary case report plus discussion

K S Krishnakumar, Kiran S Petkar, Sameer Lateef, Suresh Vyloppilli. Penile replantation. Indian Journal of Plastic Surgery. 2013;46(1):143-146. DOI: 10.4103/0970-0358.113736. PMID: 23960324. PMCID: PMC3745104. Identifiers matched from the opened article; Lee confirmation pending.

- [Full text](https://pmc.ncbi.nlm.nih.gov/articles/PMC3745104/)
- Retrieval: abstract and full clinical narrative read; discussion checked for limitations.
- Anchored excerpt, case report: “the erection and sensation in the glans could not reliably be recorded.”
- Extracted support: the reported order was urethra/spongiosum over a catheter, cavernosal arteries, corporal tunica, dorsal vessels, dorsal nerves, then loose fascial/skin closure. Viability and urinary flow were reported separately from unmeasured erectile/sensory recovery. A residual skin bridge makes this an incomplete injury, distinct from the constructed complete-amputation case. The authors warn about reporting bias.
- Stage mapping: 2, 4, 5, 6, 7, 8.
- Full text needed because the abstract does not describe the operative order or the unmeasured functional outcomes.

### P2. Geary and colleagues, primary case report

Ellen Geary, Eamon Francis, David Menzies, Gerry Lennon, Colin M Morrison, Roisin T Dolan. A case report of microsurgical penile replantation: Engaging multi-disciplinary expertise to optimise patient outcomes. Journal of Hand and Microsurgery. 2025;17(2):100203. Online 2024-12-19. DOI: 10.1016/j.jham.2024.100203. PMID: 39882353. PMCID: PMC11773072. Identifiers matched from the opened article; Lee confirmation pending.

- [Full text](https://pmc.ncbi.nlm.nih.gov/articles/PMC11773072/)
- Retrieval: full narrative read; no separate abstract appears on the opened letter.
- Anchored excerpt, clinical narrative: “severe oedema lead to progressive venous congestion necessitating return to theatre.”
- Extracted support: simultaneous identification/tagging by two teams; urethral repair before corporal reconstruction; support to reduce vascular kinking; flap monitoring. Edema-related outflow compromise required graft revision; a later urethral stricture required reconstruction. This proximal injury included adjacent tissue loss and an arterial variant, so its anatomy is not the prototype's universal template.
- Stage mapping: 2, 3, 4, 5, 6, 7, 8.
- Full text required for the complications and sequence, not available in an abstract.

### P3. Garg and colleagues, primary case report plus anatomical discussion

Sanchit Garg, Shivprasad V Date, Arunesh Gupta, Amresh S Baliarsing. Successful microsurgical replantation of an amputated penis. Indian Journal of Plastic Surgery. 2016;49(1):99-105. DOI: 10.4103/0970-0358.182257. PMID: 27274131. PMCID: PMC4878254. Identifiers matched from retrieved text and indexed PubMed record; Lee confirmation pending.

- [Article](https://pmc.ncbi.nlm.nih.gov/articles/PMC4878254/)
- [Text retrieval endpoint](https://www.ebi.ac.uk/europepmc/webservices/rest/PMC4878254/fullTextXML)
- Text retrieved without figure files.
- Retrieval: abstract and full clinical/anatomical text read through Europe PMC XML; the PMC browser page returned a challenge.
- Anchored excerpt, case report: “The cavernosal arteries were identified but not anastomosed.”
- Extracted support: urethra/spongiosum, corporal tunica, artery then deep vein, dorsal nerves, fascia, superficial vein, skin. Monitoring included color, temperature, capillary refill, bleeding, and Doppler. Skin necrosis coexisted with survival and later urinary/erectile recovery; sensory recovery was incomplete. Text describes paired cavernosa, tunica, ventral spongiosum/urethra, dorsal neurovascular anatomy and a variant.
- Stage mapping: 1, 2, 4, 5, 6, 7, 8.
- Full text required for geometry relationships, sequence, monitoring and sensory limitations.

## Stage retrieval map

This map links the teaching stages to the reviewed sources.

| Requested stage | Source anchors | Pending questions for source evaluation |
|---|---|---|
| 1. Intact anatomy and orientation | P3 anatomical discussion | Review modeled fascial layers and all cross-sectional positions against anatomical assets and Lee's review. |
| 2. Complete separation and both surfaces | P3 case narrative and cross-sectional description; P1 and P2 variation | Distinguish complete constructed injury from reports with a skin bridge, proximal avulsion, or variants. |
| 3. Assessment, preservation, coordination | G1; P2; G2 pending direct text | Keep source-backed cooling concepts; no unsourced ischemia rule or medication regimen. |
| 4. Viability and preparation | G1; P1-P3 narratives | No validated viability score was established by these retrieved sources. |
| 5. Urethral and corporal restoration | P1-P3 narratives; G1 | Explanation order requires explicit separation from operative order. |
| 6. Arteries, veins and nerves | P1-P3; G1 | Target vessels, anatomy, technical feasibility and repair order vary. |
| 7. Coverage and completion | P1-P3; G1 | Consider how the viewer represents fascia, skin, swelling and avoidance of compression. |
| 8. Monitoring and function | P1-P3; G1 | Display organ survival, skin survival, urethral patency, sensation, erection and psychosocial recovery as distinct domains. |

## Conflict and thesis-conflict inventory

These are retrieval flags for independent evaluation, not resolved recommendations.

| Candidate teaching claim to challenge | Retrieved conflict or limitation | Consequence to examine |
|---|---|---|
| Every operation uses the displayed order | P1 and P3 differ in cavernosal arterial repair and timing of superficial venous repair. G1 does not prescribe a complete strict sequence. | Label the storyboard as an anatomical teaching order; Lee confirms any later operative animation. |
| Every vessel in a schematic is repaired | G1 says cavernosal repair is often impractical; P1 repairs those arteries; P3 does not. | Separate vessel identity from mandatory repair. |
| Replant survival proves restored function | P1 lacks reliable sensory/erectile assessment; P3 reports residual sensory deficits. | Track functional domains independently. |
| A technically completed reconstruction ends risk | P2 has subsequent congestion and stricture; P3 has skin loss. | Preserve monitoring and delayed complications in the final stage. |
| One successful case establishes superiority | Retrieved primary material is case reports with injury-pattern variation and reporting/measurement limitations. | No pooled rate or comparative superiority claim is supplied. |

## Gaps and leads not admitted as full-text evidence

- G2 direct AUA PDF: version catalogue opened, full text still unresolved after direct browser and HTTP attempts. Indexed statement alone is not marked fully reviewed.
- Gautam Biswas. Technical Considerations and Outcomes in Penile Replantation. 2013. [PMC lead](https://pmc.ncbi.nlm.nih.gov/articles/PMC3842340/). Search returned abstract and case excerpts; direct PMC returned a challenge and Europe PMC XML returned HTTP 500. Excluded from admitted primary evidence. Bibliographic identifiers require direct confirmation.
- No validated universal operative order, preservation time threshold, medication regimen, comparative outcome estimate, or complete viability assessment algorithm is established by this scoped set.
- Dedicated primary anatomical dissection evidence was not retrieved. P3 supplies reported anatomical relationships, not proof of the accuracy of a new mesh. The anatomy inventory and Lee's review remain required.
- The external pudendal system, superficial drainage and distributed nerve branching need explicit decisions about schematic representation. Primary cases contain variants; the model must not silently present a variant as universal anatomy.
- No retrieved report is permission to reuse patient photographs. The prototype uses constructed anatomy.

## Duplicates and exclusions

PMC, PubMed and Europe PMC records for P3 describe one paper and are not independent observations. EAU chapter and citation page describe one guideline. AUA catalogue and PDF refer to one guideline. Case-report discussion sections contain secondary claims; only directly reported cases and explicitly identified descriptions support this manifest. Search-only articles beyond the admitted set remain leads, not additional evidence.

## Separate repair animation extension

P1 was reopened for the requested close-ups. Its case narrative describes urethral repair over a catheter, closure of each corpus through its tunica, and interrupted dorsal arterial and venous repair under magnification. This supports the structures and wall relationships selected for the constructed lessons. It does not validate their dimensions, stitch count, or timing. The modeled teaching order is corpora, urethra, then microvascular detail; it is not P1's operative sequence.

P2 retains the distinction between reconstruction and later clinical patency. P3's reported use of grafts must not be read as evidence that the new direct end-to-end illustration reproduces that case. No individual published case is reproduced by the new geometry.

The model exposes the inner surface at the urethral and vascular bites while keeping thread close to the repaired wall. This is a geometric teaching construction, not a validated needle trajectory. Preparation, spatulation, tissue handling, clamps, knot mechanics, and outcome assessment are outside the new animation's scope. No new suture caliber, medication regimen, vessel-repair mandate, or outcome claim is introduced.

## D1. Nerve Tape device-mechanism extension

User requested branded Nerve Tape, confirmed 2026-09-22. No matching source was found in the scoped vault note search. A focused primary-source check and independent review preceded implementation.

- [BioCircuit Nerve Tape IFU, 05-MAR-001 Rev 07](https://www.biocircuit.com/_files/ugd/911ff7_779238cb615740a789237d6f891e9f40.pdf): both pages read. Supports a porcine SIS wrap with nitinol microhooks engaging epineurium and sequential short/long overlapping leaves. It excludes vascular use. The indication concerns peripheral nerve discontinuities where extremity flexion can close the gap. Accurate sizing and material sensitivities require the full IFU.
- [FDA K233533 device description](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K233533.pdf): full document independently reviewed. Supports device materials and fixation mechanism; does not establish penile replantation outcomes.
- [Eberlin et al., Usability of Nerve Tape, 2024](https://pubmed.ncbi.nlm.nih.gov/38323947/): primary indexed abstract independently reviewed; full publisher text blocked. DOI 10.1016/j.jhsa.2024.01.001. Cadaveric arm testing does not establish penile applicability or sensory recovery.

The bounded search did not identify a penile Nerve Tape study. This is not proof that none exists. The website labels the scene as a device-mechanism illustration and states the penile evidence limitation beside it. It makes no comparative superiority, patency, or sensory recovery claim.