(339) Urologic and Psychiatric Considerations in Male Genital Self-Mutilation

Abstract Introduction Male genital self-mutilation (GSM) can be categorized into four subtypes – amputation, castration, mutilation, and combined amputation/castration. The most common psychiatric diagnosis associated with GSM is schizophrenia, followed by substance use disorders, personality disorders gender dysphoria. Objective We discuss a case of amputation/castration in patient presenting without his severed organ. Treatment considerations patients active psychosis due to schizophrenia are discussed. Methods A 30-year-old single male history requiring multiple prior inpatient admissions, obsessive compulsive disorder, autism spectrum disorder presented the Emergency Department penile bilateral testicular self-amputation. Upon inquiry regarding method injury, stated “someone” instructed him “cut off” penis testes pair scissors. He subsequently disposed organs flushing them down toilet. Consent was obtained from patient’s mother, who served as healthcare proxy. underwent operative intervention including “stump-plasty”, suture ligation spermatic cords, scrotal Penrose drain placement loose re-approximation skin. admitted for care management psychosis. Post-operatively he observed repeatedly touching contaminating surgical site developed wound infection. exploration washout on post-operative day 10. convalesced well after completing course antibiotics MRSA Results Operative options differ based presence or absence penis. In this penis, possible includes primary closure urethral advancement (stump-plasty), debridement delayed repair skin grafting, perineal urethrostomy. Our stump-plasty, able void while standing period. Penile replantation considered when organ has not been discarded. Considerations self-inflicted injuries secondary psychotic episode include ability provide informed consent, insight condition, severity mental illness, increased likelihood future attempts at self-harm. Severe perioperative complications, sepsis, acute kidney length stay, infections, odds having an adverse outcome. Risk factors experiences, GSM, alcohol drug use, guilt toward sexual feelings, early father loss. Patients have risk up one-third these making repeated attempt GSM. Conclusions presents organ, physician should consider history. severe physicians versus urethrostomy rather than grafting avoid Disclosure No