Review of penile reconstructive techniques

Abstract

Reconstructive surgery of the penis holds many unique challenges due to the unique physiological properties of the tissues. Much of the effort involved therefore goes to preserving as much of the native tissue as possible whilst novel and creative methods have been adopted to repair defects and in creation of neophallus. A search of the PubMed database was carried out using the following keywords: ‘penile trauma’, ‘penile cancer’, ‘lichen sclerosus’, ‘glansectomy’, ‘glans resurfacing’, ‘penile-sparing surgery’, ‘micropenis’, ‘aphallia’, ‘female-to-male sex reassignment surgery’, ‘scrotal flap’ and ‘genital lymphoedema’. Results for glans resurfacing in treating cancer showed low local recurrence rates at 0–10% whilst 90% of lichen sclerosus patients reported complete resolutions of pain and pruritis. For repairs of penile shaft skin defects the literature supports the use of full-thickness skin graft and pedicled scrotal flaps. The radial artery-based forearm free flap remains the best option for neophallus creation in terms of function, sensation and cosmesis but unfortunately leaves a disfiguring scar and involves multiple stages. Some novel techniques have been developed to circumvent these issues and are discussed. This article presents an update on the important developments in the field of penile reconstructive surgery.

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Fig. 1: Steps in total glans resurfacing.
Fig. 2: Total glansectomy with neoglans formation.
Fig. 3: Four stages of RAFF phalloplasty.

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Correspondence to David Ralph.

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Kristinsson, S., Johnson, M. & Ralph, D. Review of penile reconstructive techniques. Int J Impot Res (2020). https://doi.org/10.1038/s41443-020-0246-4

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