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Reconstructive surgery of the scrotum: a systematic review

Abstract

The term scrotoplasty embraces several techniques which aim to restore a normal scrotal appearance and function. We provide here a quick reference tool to allow the urologist to select the appropriate surgical strategy among the several available options. A comprehensive research was carried out on MEDLINE/PubMed to identify relevant studies concerning this topic, including a range of key words, e.g., scrotoplasty, ventral phalloplasty, scrotal reconstruction, scrotomegaly, penoscrotal web, scrotal lifting, scrotal reduction, scrotectomy, scrotal lymphoedema. Scrotal skin defects may be related with Fournier’s gangrene, traumatic events, and surgery for genital cancers or peno-scrotal lymphoedema. The reconstructive management of these conditions is relatively reproducible in the hands of experienced urologists, if aware of the basics of scrotal surgery. Primary tension-free wound closure and local pedicled flaps typically allow optimal surgical outcomes for repairing most of these scrotal defects, with split-thickness skin grafts (STSGs) and/or distant flaps being required only when dealing with extensive skin losses. The demand for genitals’ aesthetic surgery among adults is on the increase recently. Although the scientific evidence regarding this topic is scarce, reduction scrotoplasty and peno-scrotal webbing correction techniques are easy, safe and effective solutions to improve genital cosmesis, being carried out in isolation or in combination with penile prosthesis implantation. More robust scientific evidence is needed to achieve a uniformed consensus regarding the optimal surgical management in this broad field, and surgical innovation should continue to refine current reconstructive techniques.

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Fig. 1
Fig. 2: Postoperative appearance in a case of Fournier’s gangrene with genito-perineal involvement, one month after surgical debridement.
Fig. 3: Various degrees of genital lymphedema.
Fig. 4: Buried penis due to penile lymphedema secondary to penile cancer treatment.
Fig. 5: Meshed split thickness skin graft being used to reconstruct the scrotum.
Fig. 6: Superomedial fasciocutaneous thigh flap.
Fig. 7: Ventral phalloplasty.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Conception of the work: NS and GG; Data Collection: NS and OC; Data analysis and interpretation: NS, OC and FC; Drafting the article: NS and OC; Critical revision of the article: FC, FM and GG; Final approval of the version to be published: NS, OC, FC, FM and GG.

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Correspondence to Giulio Garaffa.

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Schifano, N., Castiglione, F., Cakir, O.O. et al. Reconstructive surgery of the scrotum: a systematic review. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00468-x

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