Penoscrotal Webbing Research Articles

Evaluation of Z-plasty versus Heineke-Mikulicz scrotoplasty in the management of penoscrotal web in pediatric age group

BackgroundThe penoscrotal web may be congenital or acquired following excessive ventral skin removal during circumcision. Several surgical techniques were described for the treatment of congenital webbed penis without a clear comparison between their outcomes. This prospective study aimed at comparing the surgical results of Z-scrotoplasty and Heineke-Mikulicz scrotoplasty in the treatment of congenital webbed penis in uncircumcised pediatric patients.MethodsOur study included 40 uncircumcised patients who were divided randomly into two groups; Group A included 20 patients who were treated by Z-scrotoplasty and Group B included the other 20 patients who were treated by Heineke-Mikulicz scrotoplasty. All patients were circumcised at the end of the procedure.ResultsThe surgical outcome was good without a significant difference between the two groups in 36 patients. Recurrent webbing developed in one patient of Group A and in three patients of Group B (FEp = 0.605) The only significant difference between the two groups was the operative duration which was shorter in Group B than in Group A (P < 0.001*).ConclusionsTreatment of congenital penoscrotal web in the pediatric age group could be done with either Z-scrotoplasty or Heineke-Mikulicz scrotoplasty with satisfactory results, however, without significant difference in the surgical outcomes.Trial registration• Registration Number: ClinicalTrials.gov ID: NCT05817760.• Registration release date: April 5, 2023.

Reconstruction of the male external genitalia in diverse disease processes: Our reconstructive algorithm, techniques, and experience.

BackgroundMale genital form and function may be rendered abnormal by a number of disease processes, with profound associated psychological and functional consequences. The aim of the study is to review our reconstructive experience with cases of genital loss or distortion due to nonmalignant diseases processes and atypical neoplasia.Materials and methodsA retrospective review of a prospectively maintained database was performed to identify reconstructive cases performed from 2018 to 2020 under the care of a single surgeon. Male patients 18 years or older with a disease diagnosis other than squamous cell carcinoma affecting genital form were included. Disease processes, patient factors, surgical techniques, and both functional and cosmetic outcomes were reviewed.ResultsFourteen cases were identified. The patients had a mean age of 52.2 years (range, 21–72 years). Acquired buried penis was present in 8 patients. Etiology of genital abnormality included balanitis xerotica obliterans (n = 6), excess skin loss at circumcision (n = 2), self-injection of petroleum jelly to penile shaft (n = 1), Fournier gangrene (n = 1), hidradenitis suppurativa (n = 1), extramammary Paget disease (n = 1), idiopathic lymphoedema (n = 1), and penoscrotal webbing (n = 1). Reconstructive techniques performed included penile debridement/shaft skin release, scrotectomy, suprapubic apronectomy, and division of penoscrotal webbing, in combination with split-thickness skin grafting where required. A penile implant was inserted in one patient. Reconstructive planning, techniques, and outcomes are described.ConclusionsA variety of reconstructive techniques in andrology can be used to improve the aesthetic and functional outcomes of multiple disease processes affecting the male external genitalia.

Reconstructive surgery of the scrotum: a systematic review.

The term scrotoplasty embraces several techniques which aim to restore a normal scrotal appearance and function. We provide here a quick reference tool to allow the urologist to select the appropriate surgical strategy among the several available options. A comprehensive research was carried out on MEDLINE/PubMed to identify relevant studies concerning this topic, including a range of key words, e.g., scrotoplasty, ventral phalloplasty, scrotal reconstruction, scrotomegaly, penoscrotal web, scrotal lifting, scrotal reduction, scrotectomy, scrotal lymphoedema. Scrotal skin defects may be related with Fournier's gangrene, traumatic events, and surgery for genital cancers or peno-scrotal lymphoedema. The reconstructive management of these conditions is relatively reproducible in the hands of experienced urologists, if aware of the basics of scrotal surgery. Primary tension-free wound closure and local pedicled flaps typically allow optimal surgical outcomes for repairing most of these scrotal defects, with split-thickness skin grafts (STSGs) and/or distant flaps being required only when dealing with extensive skin losses. The demand for genitals' aesthetic surgery among adults is on the increase recently. Although the scientific evidence regarding this topic is scarce, reduction scrotoplasty and peno-scrotal webbing correction techniques are easy, safe and effective solutions to improve genital cosmesis, being carried out in isolation or in combination with penile prosthesis implantation. More robust scientific evidence is needed to achieve a uniformed consensus regarding the optimal surgical management in this broad field, and surgical innovation should continue to refine current reconstructive techniques.

Is the simple webbed penis a contraindication to circumcision?

BackgroundSurgical correction of the webbed penis is challenging. We presented the safety and feasibility of webbed penis correction for neonates under local anesthesia using a simple principle of leaving equal cylindrical shaft skin.MethodsThis retrospective study included 530 patients who presented for circumcision to three pediatric surgery centers between May 2017 and January 2020. We included male patients aged less than four weeks old who had circumcision with a minimum of 6 months follow-up. We compared patients with normal penile anatomy (n = 451, Group 1) to a simple webbed penis (n = 79, Group 2).ResultsThere were no differences in age and weight between groups. The procedure time was significantly longer in Group 2 (8.05 ± 3.11 vs. 7.48 ± 2.07 min; P = 0.04). There were no differences in bleeding (P = 0.38), redundant foreskin (P > 0.99), need for corrective surgery (P = 0.38), and re-suturing (P = 0.28) between groups. The procedure success was significantly higher in Group 1 (449 (99.56%) vs. 70 (88.6%); P < 0.001). Parents' satisfaction was measured at two weeks with no difference between both groups.ConclusionSimple penoscrotal web is not a contraindication for neonatal circumcision. Circumcision of the penoscrotal web had good esthetic results with comparable outcomes to those with a normal penis without a web.

The concealed penis: the "two-corner" surgical technique.

Background Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized approach that is suitable for concealed penis and penoscrotal webbing. Methods From January 2005 to December 2013, patients presenting concealed penis were treated utilizing the two technique: through a midline penoscrotal incision, the superficial ventral chordee is removed, freeing the corpus spongiosum till the peno-scrotal angle. Circumferential degloving of the shaft is performed and the scrotal septum is separated from the urethra, allowing the penile shaft to pull out. The new peno-scrotal junction is rebuilt downwards, anchoring the peno-scrotal dartos corners to the peripubic tissue bilaterally and stabilizing the penile lengthening. Tension-free skin coverage is allowed by a series of Z-plasty at the penoscrotal angle avoiding circumcision if not needed. Results Forty-nine patients aged 3-14 years (mean age 4.7 years) underwent correction of the concealed penis according to our technique. Of them, 26 were primary and 23 after previous to hypospadias repair or other genital surgery. Penile lengthening varied from 1 to 2.5 cm (median 1.8 cm). Hospital stay varied from 1 to 4 days (mean 1.6 days). Follow-up ranged from 4 to 14 years (median 7.3 years). Forty-five parents were satisfied with the results (92%), while the defect was judged imperfectly repaired in four patients. Conclusions The two-corners technique allows easy and effective correction of the concealed penis in both congenital and acquired conditions. It can be performed as outpatient procedure and results are stable at long-term follow-up.

Penoscrotal Web and Its Repair in Children

Penoscrotal Web and Its Repair in Children

Megameatus intact prepuce and associated anomalies

Objective: Megameatus intact prepuce is described as subset of megalourethra or distal hypospadias by several authors. Despite suggested different operative techniques, some authors prefer not to operate this variant of penile anomaly. We aimed to evaluate 31 patients operated due to megameatus intact prepuce and associated anomalies .&#x0D; Material and methods: Thirtyone patients operated between 2008-2018 for MIP were evaluated retrospectively. All data were collected from hospital records. Patient age, application reasons, raphe anomalies, associated genitourinary and extragenitourinary pathologies, operative techniques, and postoperative complications were analyzed. &#x0D; Results: Mean age was 50 months (8-128 months). Ten of the patients had raphe anomalies. Genital raphe hyperpigmentation was seen in 1 patient, raphe deviation and bifurcated raphe was seen in6 and 3 patients respectively. Genitourinary anomalies were detected in 7 patients, bilateral undescended testes in 1 patient, penile chordee in 2 patients, ureteropelvic junction obstruction in 2 patients, penoscrotal web in 1 patient, nocturnal enuresis in one patient. Tubularized incised plate urethroplasty (TIPU) (n=5), tubularized urethral plate urethroplasty (TUPU)(n=16) and meatoplasty (n=10) were the operative techniques.&#x0D; Conclusion: . Co-occuring raphe anomalies should arise awareness of MIP among the clinicians who are engaged with the children’s medical conditions and also the possible anomalies especially in the societies which circumcision is not traditionally required. Further studies with large number series needed for better understanding of this pathology.

Association between intra-operative meatal mismatch and urethrocutaneous fistula development in hypospadias repair

The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.' To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development. We performed a retrospective cohort study on patients who underwent primary hypospadias repair at a single center from 2011 to 2018. Meatal mismatch was defined as: upstaging (meatus moving more proximally after degloving), downstaging (moving more distally after degloving), or none. Covariates included: pre-degloving meatal location, chordee severity, penoscrotal anatomy, pre-operative testosterone, and number of stages for repair. To test the association between meatal mismatch and fistula development, we constructed two, nested, multivariable Cox proportional hazards regression models with and without meatal mismatch and compared them with the likelihood ratio test. A sensitivity analysis excluded patients with <6 months of follow-up. Of 485 patients, 99 (20%) exhibited meatal mismatch, including 75 (15%) with upstaging and 24 (5%) patients with downstaging (Figure). Meatal mismatch was significantly associated with penoscrotal webbing, number of stages for repair, and pre-degloving meatal location, with downstaging being associated with more proximal meatal location. Over a median follow-up of 7.3 months (interquartile range 2.0-20.9), fistulae developed in 56 (12%) patients. On multivariable analysis, meatal upstaging was associated with a 3-fold increased risk of fistula development (Hazards Ratio [HR]: 3.04, 95% Confidence Interval [CI]: 1.44-6.45) compared to no mismatch. Meatal downstaging had similar risk of fistula development compared to no mismatch (HR: 0.99, 95% CI: 0.29-3.35). Multi-stage compared to single-stage repair was associated with reduced risk of fistula development (HR: 0.24, 95% CI: 0.09-0.66). The likelihood ratio test favored the model that included meatal mismatch. The sensitivity analysis showed similar findings. Our short-term results suggest that meatal mismatch may be an important additional consideration to the GMS score as a tool to assess hypospadias severity, counsel families, and predict outcomes. Longer-term studies are needed to enhance the precision of risk stratification in hypospadias. Meatal mismatch occurred in 20% of patients undergoing hypospadias repair. Among this cohort, meatal upstaging was associated with a 3-fold increased risk of post-operative urethrocutaneous fistula development.

Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults.

Increased scrotal laxity is a poorly defined entity often associated with discomfort while wearing loose clothes, walking, doing sports and during intercourse. In our experience, this condition is produced by an enlarged scrotal bag hanging more than 1-2cm below the tip of the penis and can be associated with persistent penoscrotal webbing. Our objective was to perform a systematic literature review addressing the diversity of this entity and its surgical treatment, as well as propose a diagnostic and therapeutic approach. A systematic search strategy was performed following PRISMA guidelines under the terms: Scrotum(Mesh), Plastic Surgery(Mesh), Reduction Surgery, Scrotoplasty, Ventral Phalloplasty, Scrotomegaly, Penoscrotal Web, Webbed Penis(Mesh), Scrotal Lifting, Scrotopexy and Scrotal Tuck. Articles referring to scrotum reduction or plasty in male genital rejuvenation context and ventral phalloplasty related to adult penoscrotal webbing correction were considered eligible for analysis. A management algorithm and surgical technique is proposed along with the results. A total of 1430 articles were found. After removing duplicates and applying inclusion and exclusion criteria, 11 articles were eligible for analysis. Most articles corresponded to case reports or surgical technique descriptions. Based on correcting excessive scrotal skin and/or penoscrotal webbing, we propose a vertical midline scrotal skin resection and a penoscrotal junction Z plasty, respectively. Aesthetic scrotoplasty and scrotal rejuvenation surgical techniques still remain as entities poorly addressed in the international literature. More reported experiences are needed in order to complement our proposed management algorithm and develop a nomenclature, diagnostic and treatment consensus. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 . Genital Surgery.

A Modified Scrotoplasty for Treating Severe Penoscrotal Webbing in Children.

To compare a novel modified W-incision scrotoplasty (MWS) operation method with the conventional V-Y scrotoplasty for treatment of severe penoscrotal webbing (PSW) in children a retrospective study was conducted on 26 children. Circumcision combined with modified scrotoplasty was used to repair the webbed penis and phimosis of children and another 32 patients undergoing V-Y scrotoplasty served as the control group. There was a statistically significant difference of angle improvements of penis and scrotum in a horizontal position (−66 ± 10; −57 ± 6, P < 0.001) and the parent satisfaction score (Five Likert Scale) (4.7 ± 0.56; 3.8 ± 0.47, P < 0.001) between the two groups. All 26 children who underwent MWS presented with no serious postoperative complications, and there was no significant difference in surgical complications compared to children treated with V-Y scrotoplasty.

Penoskrotal Perdenin Cerrahi Onarımı: Olgu Serisi ve Literatür Değerlendirilmesi

INTRODUCTION: Penoscrotal webbing (PSW) is an anomaly of penis and it includes penile and scrotal skin aberration. There are various surgical techniques for repairing PSW with different terminologies. Herein we present our surgical experience of Z-plasty procedure in these cases. METHODS: In this retrospective study, 5 patients with an average age of 46 months who were diagnosed and under follow-up for PSW, between June 2017 and May 2019 were included. Along with demographic and clinical characteristics, treatment and follow-up records were collected. RESULTS: Isolated PSW was observed in 4 patients and one patient had an associated megameatus intact prepuce (MMIP) of a hypospadias variant in addition to PSW. Circumcision and ventral prepuce reconstruction of the penis with the aid of "Z-plasty" solved problem and acceptable postoperative results were obtained. DISCUSSION AND CONCLUSION: PSW is a condition that warrants surgical treatment. During the management of these children, in the case of suspicion of penile skin abnormality at the time of circumcision, it should be deferred and should be consulted to a pediatric surgeon or a pediatric urologist. Gentle surgical treatment is recommended for a favourable surgical and psychological result

The concealed penis: the "two-corner" surgical technique.

Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized approach that is suitable for concealed penis and penoscrotal webbing. From January 2005 to December 2013, patients presenting concealed penis were treated utilizing the "two corners" technique: through a midline penoscrotal incision, the superficial ventral chordee is removed, freeing the corpus spongiosum till the peno-scrotal angle. Circumferential degloving of the shaft is performed and the scrotal septum is separated from the urethra, allowing the penile shaft to pull out. The new peno-scrotal junction is rebuilt downwards, anchoring the peno-scrotal dartos corners to the peripubic tissue bilaterally and stabilizing the penile lengthening. Tension-free skin coverage is allowed by a series of Z-plasty at the penoscrotal angle avoiding circumcision if not needed. Forty-nine patients aged 3-14 years (mean age 4.7 years) underwent correction of the concealed penis according to our technique. Of them, 26 were primary and 23 after previous to hypospadias repair or other genital surgery. Penile lengthening varied from 1 to 2.5 cm (median 1.8 cm). Hospital stay varied from 1 to 4 days (mean 1.6 days). Follow-up ranged from 4 to 14 years (median 7.3 years). Forty-five parents were satisfied with the results (92%), while the defect was judged imperfectly repaired in four patients. The "two-corners" technique allows easy and effective correction of the concealed penis in both congenital and acquired conditions. It can be performed as outpatient procedure and results are stable at long-term follow-up.

Outcome of circumcision for newborns with penoscrotal web: oblique skin incision followed by penis shaft skin physical therapy shows success

With this study, the authors compare the circumcision success rate for webbed penis circumcisions using a new, alternate method vs that using the traditional method. Data from circumcision patients presenting to the Division of Urology's circumcision clinic from January 2014 to April 2018 were reviewed. All patients who met the checklist criteria for suitability to circumcise were enrolled in the study. They were grouped into the 'normal' group if they had no penile anomalies or the 'web' group if they had a web with a straight penis. Cases with penile anomalies were excluded. The new circumcision method includes altering the circumcision site planned to be oblique, slant up, to compensate for the web, retaining slightly more ventral than dorsal shaft skin, and including home care skin physical therapy as 'push down' the shaft skin. Postcircumcision evaluation was completed within 2 weeks after circumcision, and families were followed up as needed over the study period, six months after circumcision. Circumcision success was defined as the penis shaft no longer attached to the scrotum and circumcision line below the glans corona. Of 828 boys who presented for circumcision, 652 (79%) were enrolled as they were suitable for circumcision: 355 (43%) in the normal group and 297 (36%) in the web group. The remaining 176 (21%) were excluded because they presented with a penile anomaly: buried penis (125), chordee (40), and hypospadias (11). Follow-up was carried out for 6 months. In the web group, follow-up data were obtained for 263 of 297 (89%) cases, with 261 of 263 (99%) showing success, and in the normal group, follow-up data were obtained for 327 of 355 (92%) cases, with all 327 (100%) showing success. The two web group cases (0.7%) who failed had surgical reconstruction. It is believed the high success rate for penoscrotal web circumcisions with oblique incision followed by penis shaft skin physical therapy establishes that surgical reconstruction is not required in most of these cases. It was found that newborns with a penoscrotal web and straight shaft show 99% success for circumcision, which is not different from boys without any penile anomalies (p=not significant). The authors believe the adoption of these new, alternate circumcision methods will enable boys with a web to avoid surgical reconstruction.

204 Patient and Partner Satisfaction Rates after Penile Prostheses Surgery: A Systematic Review

Setting expectations is critical to postoperative satisfaction rates for patients. Providers counseling for Penile Prosthesis (PP) often cite high levels of satisfaction, although the body of evidence (BES) supporting these claims are based on observational studies. To better understand how to counsel patients and their partners, we performed a systematic review to assess satisfaction rates after PP surgery. We performed Pubmed, Embase, and Cochrane searches for eligible articles published between 1/1/65-7/29/17 to identify articles reporting the use of PP. The BES was assigned a strength rating of A (high), B (moderate), or C (low) using the AUA rating system. We reviewed 267 articles; of which 61 study arms (SA) reported patient satisfaction rates and 22 SA reported partner satisfaction rates after PP surgery. The BES was low (Grade C). The most commonly utilized outcome measure was the percentage of patients who reported satisfaction with PP. The mean satisfaction rate for Inflatable Penile Prosthesis (IPP) was 86.2% compared to 72.1% for MP. Older patient age, revision of penoscrotal web, lower preoperative expectations, and higher partner Female Sexual Function Index scores were associated with higher satisfaction rates. Partner dissatisfaction was associated with revisions, insufficient concealment, and a sense of unnaturalness of the device.

Spinal anesthesia in children: most pediatric urologists are not on board

In 2016, the Food and Drug Administration issued a warning on general anesthetic medications used for lengthy procedures (>3h) in children younger than 3years. Spinal anesthesia can be a safe alternative to general anesthesia for many pediatric urology procedures. It can shorten total operating room (OR) time, provide excellent pain control, and allow parents to reunite with their child immediately after surgery. However, use of spinal anesthesia can also directly affect the operating surgeon (awake patient, time constraints of spinal, and prolonged preoperative time). Members of the Societies for Pediatric Urology (SPU) and European Society of Pediatric Urology (ESPU) were surveyed to get their opinions on the use of spinal anesthesia for routine pediatric urology procedures. It was hypothesized that half of pediatric urologists would favor spinal anesthesiaand that SPU members would be more likely to favor spinal anesthesia than their European colleagues. A short survey with five clinical scenarios was created. Scenarios assessed physicians' recommendations regarding timing and the type of anesthesia (general or spinal) for common pediatric urology procedures: undescended testicle, inguinal hernia, hypospadias, phimosis, and phimosis with penoscrotal webbing. Surveys were emailed to members of the SPU and ESPU. Responses and demographic information were collected and analyzed. The survey was completed by 113 SPU members (46% response rate for members who opened the invitation) and 109 ESPU members. For all clinical scenarios, < 20% of pediatric urologists from the SPU and <25% from the ESPU favor doing any procedure with spinal anesthesia. The majority of respondents practice in children's hospitals with pediatric anesthesiologists, but roughly half of the responders (54% SPU and 43% ESPU) do not think their anesthesia colleagues would be comfortable performing spinal anesthesia. Furthermore, only 51% of SPU and 36% of ESPU members discuss the possible neurodevelopmental side-effects of anesthesia with parents; similarly, less than half of all respondents think their anesthesia colleagues address these potential side-effects when obtaining consent. The only significant difference between SPU and ESPU responses was that ESPU members tended to delay penile surgery more than SPU respondents. Whether general anesthesia has any effect on the developing brain of children undergoing routine pediatric urology procedures is unclear. Yet, few pediatric urologists, independent of their region of practice, prefer spinal to general anesthesia. Collaboration in the OR is the key to success, and it is important that pediatric urologists and pediatric anesthesiologists work together to balance the benefits and risks of general and spinal anesthesia.

Additional procedures performed at time of penile prosthesis implantation: a review of current literature

Penile prosthesis implantation for treatment of medical refractory erectile dysfunction remains the gold standard. However, some men have additional pathology present such as Peyronie's Disease, penile shortening, penoscrotal webbing, buried penis or other penoscrotal anatomical abnormalities that may be addressed at the time of prosthesis implantation. Although several techniques are described, there remains a lack of data regarding the outcomes. We sought to identify the results of available literature regarding the additional procedures performed at the time of penile prosthesis implantation that provide defined surgical outcomes rather than merely describe surgical techniques. Surgical outcomes to procedures provide more realistic clinical outcome for readers than simply the description of novel techniques or expert opinions. We performed a review of the MEDLINE database to identify additional procedures performed in conjunction with penile prosthesis placement. Many procedures are described in review articles, however, with limited data regarding their outcomes. The included articles must describe additional procedures performed in conjunction with penile prosthesis placement. Perioperative office techniques and management were included if it changed the surgical technique. All abstracts obtained through search criteria were reviewed. Only articles written in English, on human subjects with documented surgical results and relevant articles were included in this study. After a thorough literature search, a total of 24 articles were identified. Penile lengthening procedures at the time of penile prosthesis comprise most of the literature on this subject. Lengthening procedures are as simple as Peyronie's plaque excision and grafting to complex sliding and lengthening procedures requiring complete neurovascular bundle and partial urethral mobilization. Additionally, aggressive cylinder sizing and prolonged postoperative cycling at home are also described. Glanulopexy may be necessary when malpositioning of the glans is present. Other options such as scrotoplasty are also available options for those patients with scrotal webs. Notably there is a paucity of published literature regarding girth enhancement, buried penis repair, hernia repair, and vasectomy at time of penile prosthesis placement. There are numerous procedures that can be performed in the same operative setting as penile prosthesis. Although the procedures do have a common goal to provide optimal postoperative natural appearance, length, straightness, girth and function, the techniques employed must be tailored to each patient as there is not a one-procedure fits all in this patient population.

MP32-07 CONCOMITANT SCROTOPLASTY DURING PENILE PROSTHESIS SURGERY: IS IT WORTH THE RISK?

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II1 Apr 2018MP32-07 CONCOMITANT SCROTOPLASTY DURING PENILE PROSTHESIS SURGERY: IS IT WORTH THE RISK? Matthew Brennan, Ryan Barlotta, Jacob Lucas, and Jay Simhan Matthew BrennanMatthew Brennan More articles by this author , Ryan BarlottaRyan Barlotta More articles by this author , Jacob LucasJacob Lucas More articles by this author , and Jay SimhanJay Simhan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1057AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penoscrotal web reduction with ventral phalloplasty during penile implantation (PI) is increasingly performed to maximize cosmesis, improve patient perception of penile length, and to also arguably optimize reimbursement following surgery. Although prior techniques have been well described, adverse events have been poorly characterized in large series. We describe our experience with a concomitant V-Y scrotoplasty (VYS) technique performed during PI with a rigorous assessment of postoperative morbidity. METHODS We reviewed our IRB approved, large single surgeon database from Nov 2015 to Oct 2017 and identified all patients undergoing PI. VYS with PI (G1) was performed only in those with moderate or severe webbing through a single penoscrotal incision (Figure 1). Adverse events were defined as any degree of wound dehiscence noted on follow-up, any operative revision, and/or device removal due to wound breakdown or infection. Perioperative data were compared between patients undergoing VYS (G1) to those that did not (G2). RESULTS Of 153 urologic prosthesis cases, complete data was available for 73 G1 and 25 G2 patients (mean age 62.3 vs. 60.8, p=0.47). Wound complications occurred at similar rates in both groups (7/73 [9.6%] vs. 1/25 [4.0%], p=0.21). For VYS patients in particular, suture re-approximation was required in 1/7 (14%) patients in the office setting and local wound care without suture placement was performed in 6/7 (86%). Importantly, one patient managed with local wound care alone failed management and developed a tubing protrusion through the skin necessitating device removal with replacement. Preoperative factors such as age, BMI, diabetes, hypertension and hyperlipidemia were not significant predictors of wound breakdown in either arm. CONCLUSIONS Concomitant VYS is technically feasible and well tolerated by many IPP patients. However, in experienced hands, we demonstrate a notable 10% rate of adverse wound related events. This finding is independent of other patient factors in a large cohort undergoing concomitant web reduction at the time of PI. Our findings are important to incorporate in preoperative counseling for motivated patients with scrotal webbing undergoing PI. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e422 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Matthew Brennan More articles by this author Ryan Barlotta More articles by this author Jacob Lucas More articles by this author Jay Simhan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Re: Correction of Congenital Penoscrotal Webbing in Children: A Retrospective Review of Three Surgical Techniques.

No AccessJournal of UrologyPediatric Urology1 Jan 2018Re: Correction of Congenital Penoscrotal Webbing in Children: A Retrospective Review of Three Surgical Techniques Douglas A. CanningMD Douglas A. CanningDouglas A. Canning More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.09.099AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Correction of Congenital Penoscrotal Webbing in Children: A Retrospective Review of Three Surgical Techniques." The Journal of Urology, 199(1), p. 294 © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 1January 2018Page: 294 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Douglas A. Canning More articles by this author Expand All Advertisement PDF downloadLoading ...

Scrotal reconstruction and testicular prosthetics.

Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.

Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision: A prospective study

The American Academy of Pediatrics (AAP) Task Force on Circumcision has called for the development of standards of trainee proficiency in regards to evaluation and technique for neonatal clamp circumcision (NCC). At the present time, there is no standardized or general consensus on patient selection for NCC. An improved method to evaluate newborns for NCC is an important first step in this process. Therefore, the authors collaborated to identify criteria useful in the evaluation of newborns for suitability for NCC, and for assessment of success after NCC and have named it "Checklist Assessment for Neonatal Clamp Circumcision Suitability." A national multi-institutional collaboration was created to obtain consensus on objective criteria for use in determining patient suitability for NCC, and for assessing post-circumcision success outcomes. Criteria included elements from detailed medical history, bedside physical examination, and post-circumcision follow-up. Patients desiring NCC were enrolled consecutively and prospectively. The Checklist was followed to determine which newborns were suited to NCC, and NCC was done in those cases. The patients' caretakers were given post-circumcision care instructions and a follow-up appointment. Post circumcision, the Checklist was followed to determine if the procedure resulted in a successful circumcision or if there were complications. A total of 193 cases were enrolled prospectively and consecutively from January 2014 through October 2014. The mean age was 15 days (1-30 days). Of those 193 patients, 129 (67%) were deemed suitable for circumcision and underwent NCC. Post-circumcision assessment showed a 100% success rate with no complications. A total of 64 (23%) cases were deemed unsuitable for NCC because at least one checklist criterion was not satisfied, most commonly: penile torsion (n=25), chordee (n=19), and penoscrotal webbing (n=19). Use of the Checklist in the present study has demonstrated a method of patient screening resulting in a 100% success rate with no complications. A high proportion of patients (33%) was identified as unsuited for NCC; however, the patient population consisted of newborn males referred to pediatric urology, and thus does not represent the general population, which is expected to have a lower proportion of unsuited patients. Regardless, the Checklist has the potential to enhance the decision-making process for both urologic and non-urologic care providers. The use of the "Checklist Assessment for Neonatal Clamp Circumcision Suitability" assessment tool improves identification of patients unsuited for NCC and thereby potentially decreases the likelihood of circumcision-related complications.