Login to Access Video or Poster Abstract: MP79-12
Sources of Funding: none

Introduction

The importance of psychosocial and sexual outcomes for patients after glansectomy or partial penectomy cannot be overstated. Penile lenght preservation and a good cosmetic apearence are essential for good functional outcomes. Despite the popular use of different skin flaps to cover the distal penile shaft, the use of grafts have been increasing during the last years. The objective of this study is to evaluate the experience with skin graft glanuloplasty.

Methods

The charts of 17 patients submitted to a total glansectomy or a partial penectomy and to a glanuloplasty with a skin graft were analysed. The age of the patients ranged from 58 to 76 years (mean of 67 years). The mean follow-up time was 16 months (minimal follow-up of 6 months). The group included 15 patients with diagnosis of penile cancer (stages I or II) and 02 patients with complications after malleable penile implants. In all patients with penile cancer the disassembly technique principle (proposed to treat distal penile deformities) was used to achieve the maximum penile lenght preservation (organ sparing surgery) . After the mobilization of the complex urethra, glans, tumor, skin and dorsal plexus, a partial penectomy was performed in 4/15 patients (26,7%) and a total glansectomy in 11/15 (73,3%). After the oncological ressection, the glanuloplasty was performed. First, a corporoplasty to modify the shape of the distal penile shat ( to become more cylindrical) . After, the fixation of the spatulated urethra on the top penile shaft, the dorsal plexus and the penile skin creating an area for neoglans . A split-tickness skin grafts harvest from the thigh was used to the glanuloplasty in 14/17 patients ( 82,3%) and a full tickness skin graft in 3/17 cases (17,7%) Additional cosmetic procedures was used in 5 patients (29,4%) - suspensory ligament release, ventral phaloplasty, and suprapubic lipectomy.

Results

None patients had local recurrences during the follow-up period. None urethral complications (meatal stenosis) were observed. All patients are able to urinate in a standing position. Erection was preserved in 12/17 patients (70,6%) and 8/12 (66,7%) refered sexual intercourse. The patients satisfaction was excellent and all patients were satisfied with the cosmetic results and considered that they expected a penile lenght lower and a worse cosmetic result than was observed in the postoperative period.

Conclusions

The use skin graft glanuplasty in the scenario of the organ sparing glasectomy or partial penectomy seems to be a safe option for the treatment of penile cancer with involvement of the distal portion of the penile shaft, offering the high functional and cosmetic outcomes.

Funding

none