title: Simple, safe, and satisfactory secondary penile enhancement after near-total oncologic amputation.
abstract: After oncologic penile amputation, the penile stump may prove of insufficient length, causing poor personal hygiene and scrotal excoriation and an inability to void while standing. In these cases, penile enhancement by uncovering its subcutaneous parts may offer a simple and satisfactory solution.From August 2003 to August 2007, penile enhancement was performed in 6 patients with a mean age of 63 years (range, 51-69 years) and only 1 cm (range, 0-1.5 cm) of remaining penile length when standing up.The skin on the penile stump was used to recreate a neoglans. The subcutaneously covered penile shaft was dissected deep to Buck's fascia up into the deep suspensory ligament. Ventrally, the bulbospongeous muscle was laid bare over 1 to 2 cm. After resection of pubic subcutaneous fat, the pubic and scrotal skin edges were anchored to the suspensory ligament, bulbospongious fascia, and tunica albuginea. The resulting bare surface of the penile shaft was covered by a skin graft.Partial neoglandular skin slough was observed in 2 patients and could be treated conservatively in both. Penile lymphedema was observed in the 1 patient whom had previously undergone radiotherapy. This was treated by secondary subcutaneous resection and skin tightening. At a mean follow-up of 2.5 years (range, 1-5 years), the cosmetic appearance was acceptable in all patients and their penile length ranged from 7.5 to 9 cm. All were able to void while standing without soiling themselves.
authors.affiliation: Department of Plastic and Reconstructive Surgery, NCI-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam NL-1066 CX, The Netherlands. j.jorishage@inter.nl.net
authors.forename: J Joris
authors.initials: JJ
authors.lastname: Hage
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*