Skin grafting in penile reconstruction

MANAGEMENTOFMALESEXUALDYSFUOJCTION/PENILESURGERY Tuesday, February 26,15.30-17.00 hrs,RoomII

P40

THE APPLICATION OF OPEN ENDOSCOPY FOR AUGMENTATION

706

705 ALBUGINEA-SAPHENOUS RELIABLE TECHNIQUE

“GASLESS” VIDEOASSISTED FALLOPLASTY

KourbatovDimitry Department

GRAFTS: AN FOR ENLARGEMENT

EFFECTIVE AND PHALLOPLASTY

Colombo Fulvio, Guarneri Andrea, Cazzaniga Alberta, Ceresoli Andrea, Grass0 Macola Gaetano, Kartalas Goumas Joannis, Austoni Edoardo

of Urology, Clinical Hospital 6, Moscow, Russia

INTRODUCTION & OBJECTIVES: Nowadays, endoscopic technique widely applied for the performance of many conventional surgical operations. However. the management of some andrological problems hasn’t yet been successful. There are many alternatives to the conventional augmentation falloplasty but none of those techniques can be considered as the “gold standard” therapy. As a rule, their performance entails the need to make wide incisions resulting in rough scars. The penile girth enhancement methods also have many disadvantages. The application of endoscopy for a penis length and girth enhancement with minimum incisions would be of great benefit for a patient. MATERIALS & METHODS: We have got an initial clinical experience of the videoassisted endoscopy (OGVE) for the application of open “gasless” augmentation falloplasty. II patients (age 23-35) have been operated for the enhancement of the girth and/or length of the penis. Indications for operations were small penises with length in a state of erection less than 10-l I cm. The suspender and fundiforme ligaments were sectioned through a small 2.5 cm incision in the pubic area by means of OGVE. Girth enhance was performed using one or two vascularised subcutaneous fat flaps, also taken by OGVE from low abdomen wall region with the base near the pubic bone. Subcutaneous space was created around the penis by finger and OGVE dissection. Fat flaps were rotated downwards and stuffed in that space. Then the tips of flaps were fixed in the aubglanular area and to the Buck’s fascie beneath the pubic bone. Mini drains in to the subcutaneous space were placed. Every patient used weight device after operation. RESULTS: After augmentation falloplasty erected penile length enlarged at 2.2. 3.3 cm, and penis girth increased by 3.6-4.5 cm following 3-5 month postoperatively. All patients were satisfied with surgical correction. CONCLUSION: The application of endoscopy for a penis length and girth enhancement is considered to be potentially useful tool and rather beneficial for patients resulting in excellent functional and cosmetic outcome.

Department and School of Urology, University of Milan, S. Giuseppe HospitalAfaR, Milan, Italy INTRODUCTION & OBJECTIVES: Since 1995 we have been using an original technique that enables penile enlargement to be achieved by means of enhancement surgery on the corporal albuginea. We now are able to report the long-term results of our case-load. MATERIALS & METHODS: Between 1995 and 1998, 48 patients who wished to increase their penile diameter underwent enlargement phalloplasty with bilateral saphenous grafts. Patients considered eligible for surgery were either patients with penile hypoplasia (reconstructive surgery) or functional penile dysmorphophobia (cosmetic surgery). The average pre-operative penile diameter in a flaccid state and during erection was found to be 2.2 cm (1.6-2.9 cm) and 3.1 cm (2.2-3.9) respectively. Before surgery the patients were informed of the experimental nature of the surgical procedure, of the possible complications and of the need for a thorough follow-up for study purposes during the nine months following the operation. The increase in volume of the corpora cavernous was achieved by placing saphenous grafts into bilateral longitudinal openings in the albuginea along the whole length of the penis. A clinical check-up was carried out 9 months after surgery. Telephone interviews were used for the 2-year follow-up. RESULTS: The average post-operative diameter of the flaccid penis was found to be 2.5 cm (1.7-3.2), with a statistically significant difference (p
708

707 HOW TO MANAGE PATIENTS REFERRING TO ANDROLOGICAL CLINICS FOR PENILE LENGHTENING PROCEDURES

SKIN

Mondaini

Rees Rowland,

Nicola’,

Gordon’.

Gontero

Caldarera

Ponchietti

Roberto’

‘Urology,

Careggi

Hospital,

‘Urology, King’s Hospital,

at the numbers

Clinical

history,

examination compared

of patients

including

recently

published

estimate

the length

the

presenting

length

of

circumference.

(Eur.

size.

according

No

patients

when (37.3%)

they

felt

39: 183-6).

“normal”

patients

one patient

thought

also

complained

a “normal”

IO (IS%)

penile

demonstration \urrery.

should

men

penis

were

be made

also

asked

to

subjects was

recalled

smaller

In our

helpful.

WC

&

carcinoma balanitis

Grafting

METHODS:

(mean age 42 years).

The aetiology

in 7 patients, Foumier’s xerotica

obliterans

and

was performed

of the patients’

gangrene

under

series,

suggest

in any men wcking

their

should

their

none

in the

erotic

Grafts

complications

were

assessed

for

were reviewed.

on penile

grafts were used in 12 cases with good take in 83%

successful,

prior to grafting resulted in

result. The use of split-skin graft on the glans was universally

but when used in the shaft resulted in a constriction

that inhibited

surgery

could be

CONCLUSION:

The use of split-skin

graft has been found to be a valuable

and none any

to show them how

documentation

Split-skin

erectile function, despite good take.

images.

lengthening

RESULTS:

a less satisfactory

In 25

of the patients

an opinion

patients

was: penile

in 2 patients, and single cases of

lymphoedema.

(10/12) and partial take in 17% (2112). Radiotherapy

“normal” percentile

were.

to our nomogram that

penile

starting

friend%’

after seeing

by the

range from

the 2.5

the problem

than

on fourteen

conditions

22 (32.8%) only

not able to eshmate

in the teenageyears

length. Moat

we

length

found the use of a nomogram

abnormality. to other

and

about

anatomical

penile

and

in the nomogram

tlaccid.

penis according

compared

length

was worried

classified as having a severely short they

MATERIALS

physical states

while

(I .5%)

both

disease.

age

correction.

accurate

were

show that most men who seek penile

penile

a median

penile

surgery

three years of experience of using grafts to treat benign, malignant and traumatic

over a

norms.

stretched

In penile reconstructive

cosmesis and function, and the postoperative

(22.4%)

started

of

fully

of a short penis only

42 (62.7%)

the problem

with

an

described

All

clinic

surgical

& OBJECTIVES:

seeking

penis.

of I2 cm).

their

CONCLUSION: Our data ocerestrmate

and

wa\ found to have a penile length

patient

to our nomogram.

childhood,

I5

and

measures

flaccid

range as previously

and only

patients

value

the

patients

and requesting

concerning

both

sired

penis.

57 (85%)

5

Urol.2001:

and erect,

IO to 17 cm (median penile

Urology. Institute of Urology, London. United Kingdom

full thickness and split skin grafts can be used. The aim of this study is to review

We wished

the accepted

sixty-seven

desired

of male patients

penis size with

questionnaire

reference

the

Minhas Suks, Kalsi Jas. Ralph David

Messina

is increasing. andrology

IIEF

RESULTS: 44 (65.7%) complained erect

Muir

RECONSTRUCTION

Andrea’,

“Urology.

to a University

penis”

in

of a normal

The number

of “short Data

recorded

to the normal

tlaccid

Kingdom,

of “short penis”

We evaluated

obtained.

were

both

United

their perceived

complaining

were

while

Filippo’,

Concerns about penile size and a

for the problem

and correlate

16-55)

circumference

London,

in the male population.

MATERIALS & METHODS: of 27 (range

Loro

INTRODUCTION

consultation

two year period

Di

Stefano' , Bongini

Biscioni

*Urology, Novara Hospital, Novara, Italy.

Italy,

Hospital.

& OBJECTIVES:

penis are common

to look

Alessandro’,

Italy

INTRODUCTION longer

Natali

S. Sriprasad’,

Florence,

College

Messina,

an andrological

Paolo’.

EmanueleJ.

IN PENILE

GRAFTING

of

wch

lengthening

a

technique

in penile reconstructive

surgery

penis. However on the shaft, a full-thickness

on both the shaft and glans of the graft is advisable to minimise the

risk of contracture. European Urology Supplements 1 (2002)No. 1, pp. 179