Penoplasty with T-shaped incision and three-point fixation for concealed penis / 中华男科学杂志

<p><b>Objective</b>To search for a safe and effective method of penoplasty with low incidence of complications for concealed penis by evaluating penoplasty with T-shaped incision and three-point fixation in comparison with modified Devine's technique.</p><p><b>METHODS</b>We retrospectively analyzed 169 cases of concealed penis treated in our center by penoplasty with T-shaped incision and three-point fixation (group A, n = 110) or modified Devine's surgery (group B, n = 59). We compared the operation time, postoperative complications, and recurrence rate between the two groups of patients.</p><p><b>RESULTS</b>Operations were successfully completed in all the cases, the urinary catheters removed at 3 days and the elastic bandages applied for 2 to 4 weeks. The patients were followed up for 4 to 12 months. The penis was satisfactorily exposed. The operative time was significantly shorter in group A than in B (［52.8 ± 6.9］ vs ［61.5 ± 10.6］ min, P < 0.001), the postoperative complication rate was obviously lower in the former than in the latter (prepuce edema: 17.27% ［19/110］ vs 33.89% ［20/59］, P = 0.021; bleeding: 0.90% ［1/110］ vs 3.38% ［2/59］, P = 0.552; skin necrosis: 0.90% ［1/110］ vs 5.08% ［3/59］, P = 0.123; skin infection: 0.90% ［1/110］ vs 5.08% ［3/59］, P = 0.123), and so was the recurrence rate (0.90% ［1/110］ vs 6.77% ［4/59］, P = 0.032).</p><p><b>CONCLUSIONS</b>Penoplasty with T-shaped incision and three-point fixation deserves to be popularized clinically for its advantages of minor invasion, clear exposure, reliable penile fixation, low incidence of postoperative complications and recurrence, and satisfactory outcomes.</p>

Penoplasty with a Sensate Radial Forearm Free Flap after Removal of Paraffinoma / 대한비뇨기과학회지

A 33-year-old man who self injected paraffin into his penis to facilitate an erection and increase his potency suffered from diffuse ulceration and a wide defect on the penile skin involving the proximal glans to the penopubic junction with a high fever. The compromised skin and subcutaneous tissue had to be completely removed and a sensate radial forearm free flap was performed around the penile shaft. This method gave the patient excellent satisfaction in both cosmetic and sexual function. Therefore, this method might be a good therapeutic alternative, especially for young adults indulging in active sexual activity and suffer from wide skin defects even though this operation is expensive and not easy.

Engineered Tissue for Augmentation Penoplasty Using Chondrocytes and Biodegradable Polymers / 대한비뇨기과학회지

PURPOSE: Materials used in penoplasty have several disadvantages upto now. It would be attractive to make enough tissue without any drawbacks for plastic surgery from autologous tissue. In this study we have pursued to reconstruct cartilaginous tissue feasible for penoplasty by tissue engineering using chondrocytes and polyglycolic acid (PGA) polymers. MATERIALS AND METHODS: Chondrocytes were harvested from articular joint of swine and expanded by culture. Cells were seeded onto sterilized PGA scaffolds designed in various shapes at a concentration of 5x107/ml. Total 28 cell-polymer complexes and 8 polymers without cell (control) were implanted onto 12 nude mice. They were sacrificed 1, 2, 4 and 8 weeks after implantation to get the implants. Gross and histologic analysis were performed including hematoxylin & eosin (H-E) stain, toluidine blue stain. RESULTS: All the animals were grown without any complications. Milky firm predesigned-shaped cartilaginous tissues were obtained at 8 weeks after implantation grossly. Histologically mature cartilage-like structures were found in the 8 week's retrived tissue in H-E and toluidine blue stains. Almost all the polymer structures were degraded at 8 weeks. CONCLUSIONS: Cartilaginous tissues were reconstructed successfully using chondrocytes and PGA polymers by tissue engineering in vivo. These elastic structures could be used for penoplasty instead of other materials if confirmed about safty in human. This study showed possibilities to apply this technique in the fields of plastic and reconstructive surgery.

Scrotal flap penoplasty of the paraffinomas penis: 15 years of experience.

A two-stage scrotal flap penoplasty was carried out on a paraffinomas penis. In the first stage, total excision of the penile paraffin-containing skin was performed; The denuded penis was embeded in the subcutaneous tunnel of the scrotal sac. A scrotal skin flap for covering the penile shaft was separated after four months. During the past 15 years, a study was undertaken on 174 patients with an average age of 44 years (figure I). A satisfactory result was found in 148 patients, with 26 cases having required minor corrective surgery (table 1). Satisfactory sexual function was found in 168 patients, mildly painful intercourse in four patients and impotency in two cases (table 2). The post operative complications (table 3) were mild graft infection in 32 patients, partial graft necrosis in 11 cases redundant penile skin in 16 cases and tortious shape of the scrotum in 15 cases. All the patients presented to the hospital, complaining of abnormal penile shape and unsuccessful sexual intercourse.

Extensive Penis Paraffinoma: Treatment by Penoplasty Using Various Scrotal Flaps and Radial Forearm Free Flap / 대한남성과학회지

PURPOSE: There is no single method of choice for penoplasty in extensive penile paraffinoma, and surgeons must choose a suitable method according to the condition of each individual patient. Herein, we present 19 cases of extensive penile paraffinoma treated with various scrotal flaps or a new method involving a radial forearm free flap. PATIENTS AND METHODS: We reviewed the 19 cases of penile paraffinoma, which affected the whole penile skin with or without involvement of the scrotal flap 5 cases, an "apron" scrotal flap in 4 cases, and a bipedicle scrotal flap in 3 cases. Because of his underdeveloped scrotum, a new technique, radial forearm free-flap penoplasty, was done in one patient with Klinefelter's syndrome. The postoperative results were satisfactory in all except six cases. One of these was managed by a secondary full-thickness skin graft for partial scrotal flap necrosis, and the others were managed by secondary simple repair for wound disruption and infection. All patients were satisfied with the cosmetic and functional results of the scrotal flap. CONCLUSIONS: Because of their great elasticity, scrotal flaps are extremely advantageous for the repair of an extensively denuded penis. A radial forearm free flap, perhaps including the subcutaneous tissue, a long vascular pedicle, and less hair, is an alternative method when a scrotal flap is not available. Its biggest drawback is the unpleasant appearance of the donor site, which is closed with a split-thickness skin graft.

Augrnentatien Penoplastf with Autogenous Dermal Fat Graft / 대한비뇨기과학회지

PURPOSE: Augmentation penoplasty with autogenous dermal fat graft was determined to be able to perform for increasing the volume of penis. MATERIALS AND METHOD: Augmentation penoplasty with autogerlous dermal fat graft was performed on thirteen cases with micropenis or short penis due to concomittent urogenital conditions from Mar 1995 to Dec. 1996, and followed up their clinical courses. RESULTS: Postoperative penile girth was significantly increased comparing to penile length after 3-20 months(mean 12.6 months) of follow-up(p<0.05). Complications were seen in 7 patients(53.8%), which consisted of 1 skin necrosis as a serious complication, and 3 penile asymmetries, 2 penile edema and 1 painful nocturnal erection as a transient mild complication. Overall satisfaction was inquired on about two-third of all patients. CONCLUSIONS: Augmentation penoplasty with autogenous dermal fat graft may be helpful to enhance the penile girth if it is performed with expert surgical skill, but this procedure should be undertaken with full and frank medical approach including patient selection and postoperative reassurance.

Penoplasty Using Liposuction in the Treatment of Concealed Penis / 대한비뇨기과학회지

In obese children, the phallus may be camouflaged by excessive deposition of fat at prepubic area. Recently, concealed penis has begun to receive the more attention about possibility of its urologic correction. Between February 1993 and February l994, we treated 5 patients with concealed penis. All patients were prepuberty, their phalli are palpated normal in size and no specific abnormal findings were detected in preoperative evaluation including physical examination, laboratory examinations (CBC, platelet, PT, PTT, liver function test, urinalysis, hormonal assay, chromosomal study). 2 of 5 patients were circumcised and 1 of 5 patient had a history of penoplasty without liposuction. The phallus length were measured 0cm to 0.5cm (mean 0.2cm) preoperatively, 3.5cm to 4.5cm (mean 4.0cm) postoperatively and 3.5cm to 4.2cm (mean 3.9cm) at 3 months after operation. In conclusion, we suggest that penoplasty using liposuction produces a good functional and cosmetic results.

Clinical experiences of urethroplasty and penoplasty with vascularized scrotal pedicle flap on complicated cases / 대한비뇨기과학회지

There is no single method of choice for urethroplasty in the hypospadias and the posterior urethral obstruction and for penoplasty in the paraffinoma. Surgeons must choose a suitable method according to the condition of each individual patient. Herein we experienced severe formed posterior urethral stricture after traffic accident, complicated or severe formed hypospadias and completely denuded penis due to paraffinoma on IV cases from March. 1990 to September. 1992 in our hospital. We used vascularized scrotal pedicle flaps for urethroplasty and penoplasty. So, we herein report that the vascularized scortal pedicle flap is better than the other flaps in vascularity and elasticity. In posterior urethral obstruction and pararfinoma, there is no considerable complication after the surgery using the flap, but in 14 cases or hypospadias, 2 cases of urethro-cutaneous fistulas, 3 cases of meatal stenosis and 1 case of skin necrosis were noted.