Functional and aesthetic outcome after ventral spatulation of urethra in partial penectomy

Abstract

Partial penectomy is one of the common organ preserving procedures for penile malignancies and certain benign conditions. Partial penectomy causes psychosexual morbidity to the patient. Dorsal spatulation of urethra is classically done while performing the procedure, it carries risk of meatal stenosis along with compromised cosmesis. Several complex neoglans reconstructive techniques exist to prevent stenosis and improve cosmetic outcomes. We hereby describe outcomes of a simple and reproducible modification of the procedure by ventral spatulation of the urethra. An analysis of 31 partial penectomies from May 2016 to June 2019 using a ventral spatulation technique was done. Patients were followed up for an average of 1 year to look for meatal stenosis, the morphological appearance of residual stump and psychosexual well-being. None of the patient had meatal stenosis on follow up. All patients had a satisfactory cosmetic outcome, scoring 6 or more on ANA scale. Seventeen patients reported "satisfied", six scored "highly satisfied "and eight were "harmonic" with the outcome. Out of 31, significant patients (20) were sexually active with most of them "equally satisfied or dissatisfied" or "very much satisfied." Used uncommonly, ventral spatulation of urethra is a simple, reproducible and less time consuming alternative, which avoids the chances of meatal stenosis and gives goodcosmetic results with psychological benefits to patients.