Use of a prefabricated tunica vaginalis fascia flap to reconstruct the tunica albuginea after recurrent penile prosthesis extrusion.
OBJECTIVE
Although a penile prosthesis usually perforates into the urethra, it can extrude through the glans or corporeal shaft. Various materials have been used to reconstruct tunica albuginea but no method of repair has been satisfactory in such difficult cases. Repair of the weakened tunica albuginea should ideally be performed with autogenous tissues. Inasmuch as the scarred tissue bed is inadequate to ensure graft survival and no local flaps are available for this purpose, prefabrication of a local flap has been designed.


METHODS
We present 2 cases in which the distal corpus was reconstructed with a prefabricated tunica vaginalis fascia flap. The first stage involves grafting rectus fascia onto the external tunica vaginalis of the testicle. At the second stage the prefabricated tunica vaginalis fascia flap is transposed to the distal corpus, placing it as a buttress between the cylinder and urethra medially or between the cylinder and thin lateral and distal tunica albuginea. The flap also replaces part of the tunica albuginea.


RESULTS
In both patients repair of the tunica albuginea was successful and each has a functioning inflatable penile prosthesis at 2 1/2 1 1/2 years postoperatively, respectively.


CONCLUSIONS
Reconstruction of the weak tunica albuginea with a prefabricated tunica vaginalis fascia flap is an excellent procedure in these difficult cases.
Alter
G J
GJ
Division of Plastic Surgery, UCLA School of Medicine, USA.
Greisman
J
J
Werthman
P E
PE
Seid
A S
AS
Joseph
B J
BJ
D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation; D015917:Penile Prosthesis / Q000009:adverse effects*; D013524:Surgical Flaps; D014521:Urethra / Q000293:injuries* / Q000601:surgery