title: Glans-reconstruction with preputial flap is superior to primary closure for post-surgical restoration of male sexual function in glans-preserving surgery.
abstract: We conducted this study to investigate whether glans-reconstruction with preputial flap would be more helpful for post-operative restoration of patients' sexual potency than primary closure. From 2007 to 2013 at four centres, 46 cases reconstructed with preputial flap and 59 with primary closure were selected for the investigation from 142 consecutive cases of superficial glans cancer, with the largest diameter of lesion ≤2.5 cm, who undergoing glans-preserving surgery (GPS). Subjective evaluation for patients' sexual performance was investigated using the International Index of Erectile Function-15. Objective evaluation was carried out by the Audio Visual Sexual Stimulation test with RigiScan-Plus. The degree of satisfaction for penile appearance and patients' confidence and partners' acceptability for intercourse were evaluated by 5-point scales. Patients with preputial flap reconstruction showed significant better performance in three domains (orgasmic function, intercourse satisfaction and overall satisfaction, all p < 0.05) and significantly higher ratios of appearance satisfaction (78.3% vs. 57.6%, p = 0.026) and intercourse confidence (69.6% vs. 49.2%, p = 0.035) compared with those undergoing primary closure at post-operative month 6 ends. Their sexual partners in the preputial flap group also exhibited significantly higher ratios of appearance satisfaction than in the primary closure group (67.4% vs. 42.4%, p = 0.011). Reconstruction with preputial flap contributes to a more acceptable cosmetic appearance of the penis and minimizes post-operative negative psychological impediments. Patients can benefit more from reconstruction with preputial flap than primary closure. Glans-reconstruction with preputial flap should be considered the primary reconstruction technique in GPS.
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: X-F
authors.initials: XF
authors.lastname: Wu
authors.forename: N-J
authors.initials: NJ
authors.lastname: Song
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: D
authors.initials: D
authors.lastname: Qiao
authors.forename: J-Y
authors.initials: JY
authors.lastname: Zhang
authors.forename: N-H
authors.initials: NH
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D003075:Coitus; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010412:Penile Neoplasms / Q000601:surgery; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: glans reconstruction; glans-preserving surgery; male sexual function; penile cancer; preputial flap; psychosexual health