Rapper Andre Johnson’s failed penis reattachment: What went wrong?

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Rapper cuts off penis

Suicide attempt goes from bad to worse

Rapper Andre “Christ Bearer” Johnson reportedly amputated his own penis before jumping off a building in an apparent suicide attempt on Wednesday.

Though Johnson, a member of the rap group Northstar, was rushed to Cedars-Sinai Medical Center in Los Angeles, attempts to reattach his severed penis failed, according to TMZ.

Though it’s unclear what went wrong during Johnson’s reattachment procedure, Dr. Doron Stember, assistant professor of urology at the Icahn School of Medicine at Mount Sinai in New York City, said the success of these surgeries often depends on what occurs in the immediate aftermath of the amputation.

“The most important thing is, the penis should be attached as quickly as possible,” Stember, who has not treated Johnson, told FoxNews.com. “The best way to transport the amputated penis is to put it in a plastic bag and put that plastic bag in another plastic bag with ice and slush, which cools it, and then get into the operating room as quickly as possible.”

To give a patient the best chance of experiencing a successful reattachment, he needs to be in an operating room within six hours of experiencing the amputation, according to Stember. Though successful reattachments have been reported up to 16 hours after an amputation, any attempts to reattach the penis beyond that point would likely fail.

Time is crucial because the tissue on an amputated organ will quickly become necrotic and begin to die – leading to complications and increasing the odds that the reattachment will be unsuccessful.

“The goal is to reattach the penis, and you want to preserve normal penile length, cosmetic appearance, erectile function, sensation of the penis and maintaining the ability to urinate,” Stember said.

Before his surgery, Johnson likely received a suprapubic catheter, allowing doctors to drain urine through his lower abdomen. Then, surgeons likely attempted to remove any necrotic tissue on both the amputated and remaining portions of the penis.

“The first thing you do is remove the necrotic tissue…then realign the urine channel, reattach the erection chambers to each other and use an operating microscope to reattach the nerves, arteries and veins,” Stember said.

Access to an operating microscope and a surgeon trained in surgical microscopy play a key role in the success of a surgery.

“When that’s available…there are pretty good success rates, 85 percent will have some degree of erectile function and penile sensation,” Stember said. “But when it’s not used or a [specially trained] surgeon not available, it is a much lower success rate, closer to 20 percent.”

Stember theorized that Johnson’s penis may have become necrotic, meaning the tissue in the amputated portion began to die, making it difficult to reattach.

“Most likely, the [amputated] part was ischemic, so it looked dark or dusky and once they attached it they didn’t see the color become more pink,” Stember said. “You want the amputated portion to be re-vascularized and a good way to look at it is the color of the penis; you want to see [a] gradual increase in size and redness, and you can do an ultrasound to look at blood flow. And if you’re not seeing that after some period of time, it’s likely not going to work.”

In the case of a failed reattachment, a patient’s options often depend on the length of the remaining penis. If some portion of the penis remains, the patient may still have the ability to experience erections, and can choose to undergo surgery to sever the suspensory ligament that attaches the penis to the pubic bone.

“It doesn’t lengthen the penis, but gives the appearance of a longer penis,” Stember said. “…It allows the remaining penis segment to hang a little further away from the body and that may enable more normal upright urinating.”

However, if only a very small portion of the penis remains, the patient will likely experience very little or no erectile function. They can also experience difficulties with urination. In this scenario, one option for the patient is to undergo surgery to tunnel the urine channel below the scrotum, allowing them to urinate sitting down. Another option is to undergo a reconstruction of the phallus.

“This isn’t done on an emergency basis, but later, they can take tissue, usually from the forearm and reconstruct the phallus,” Stember said. “…Sexual function is invariably poor or nonexistent in terms of erections but they might have a better cosmetic appearance and the ability to urinate standing.”

Johnson will likely have a urinary catheter in place until he and his team of doctors can assess the length of his remaining penis and determine the best path of treatment.

Though it is unclear what provoked Johnson’s suicide attempt and self-mutilation, members of Johnson’s rap group have speculated that he may have had a mental problems. Stember noted that patients with severe mental issues may be vulnerable to even more problems during recovery.

“It’s known you have to be careful with these patients, a big concern is that a patient may attempt to reinjure himself,” Stember said.

Johnson will likely undergo prolonged psychiatric care in the future.

“[The failed reattachment], it’s very anxiety provoking for cosmetic and functional reasons both, and is something he will have to deal with,” Stember noted. “And anyone who attempts suicide and mutilates themselves by definition will need serious, intensive psychiatric care, regardless of the outcome of penile reattachment.”