Background <p>Penile amputation is a rare urological emergency that requires prompt surgical intervention and comprehensive medical evaluation. Microsurgical replantation is considered the preferred approach when feasible; however, macroscopic repair may provide satisfactory outcomes in resource-limited settings. Reports of successful penile replantation in very young children remain exceedingly rare.</p> Case presentation <p>A 4-year-old boy presented with near-complete penile amputation. Following initial resuscitation and stabilization, surgical re-implantation of the penis and urethral reconstruction were performed. Due to the unavailability of microscopic equipment, neurovascular anastomosis of the penile dorsal complex could not be carried out. A Foley catheter was maintained for a relatively prolonged period postoperatively for 20 days. Despite the absence of microsurgical repair, the patient demonstrated satisfactory early cosmetic appearance and normal voiding behavior during 38-month follow-up.</p> Conclusions <p>This case suggests that macroscopic penile replantation may provide favorable cosmetic and urinary outcomes in selected pediatric patients when microsurgical facilities are unavailable. Prompt intervention and meticulous surgical reconstruction remain critical for achieving satisfactory results. However, longer-term objective functional evaluation into adolescence remains necessary.</p>