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Total penectomy results in a disfiguring anatomic situation which may have a devastating effect on the patient's psychologic health. Here we report our experience with construction of a penoid by covering a transpositioned testicle with remaining penile skin after radical penectomy in 2 patients with malignant underlying disease.

Major scrotal and penile skin loss is uncommon and management of such an injury is a challenging problem for genitourinary reconstruction surgeons. Less than 50% scrotal skin loss can often be closed without difficulties immediately after trauma with surrounding tissue. In cases of more significant skin loss, the testes may be preserved by placing them in thigh pouches or dressed with wet dressings until reconstruction, or split thickness skin grafting can be performed. The surgeon’s decision depends on the cause of skin loss – trauma, Fournier‘s gangrene or others. We describe a case of massive scrotal and penile skin loss due to an incident with an agricultural machine. The scrotal reconstruction, performed in three steps, was chosen because of its simplicity, early closure of the wound, excellent cosmetic appearance and maintenance of sexual functions. In the first step the penis was covered with remnant scrotal and preputium skin, and the testes were placed in thigh pouches. Incision of thigh flaps was planned to perform the second step and finally scrotal reconstruction with thigh pedicle flaps was done. Results were satisfactory from an esthetical and functional point of view.

Introduction: Different types of grafts have been described in urethral reconstruction (UR), with penile skin graft (PSG) and buccal mucosa graft (BMG) as the most frequently used ones. It still remains unclear whether one graft is superior in terms of success when compared to the other. Material and Methods: A systematic review of the literature was performed searching the MEDLINE database with the following search strategy: ‘urethroplasty’ AND ‘penile skin’/ ‘urethroplasty’ AND ‘buccal mucosa’. 266 and 144 records were retrieved for urethroplasty with PSG and BMG, respectively. These records were reviewed to identify papers where PSG and BMG were used in UR and where individualized data on success were available within the same series. Results: 18 papers were found eligible for further analysis. In total, 428 and 483 patients were respectively treated with PSG or BMG. If available, follow-up duration was 64.1 versus 42.1 months (p < 0.0001) and stricture length 6.2 versus 4.6 cm (p < 0.0001) for PSG and BMG, respectively. Success of UR with PSG was 81.8 versus 85.9% with BMG (p = 0.01). Conclusions: Success of UR using BMG is significantly better compared to PSG. Results might be seriously biased by a longer follow-up duration and stricture length for PSG compared to BMG.

A man presented with a concealed penis which developed after circumcision. In addition to anatomic variations in penile skin attachment and obesity, circumcision is an iatrogenic cause in the etiology of a concealed penis, Although it is a frequent and simple operation, it may lead to uncommon complications due to a lack of experience and poor technique. Copyright (C) 2001 S. Karger AG, Basel.

Sixteen patients, between 2 and 45 years old, with hypospadias underwent repair with our new skin closure procedure called ipsilateral penoscrotal approximation for closure (IPSAC). Complete functional success was obtained in all 6 patients with distal hypospadias and in 7 of 10 patients with proximal hypospadias. Meatal regression and urethrocutaneous fistula were complications in one-stage repair. Another urethrocutaneous fistula resulted from fifth-stage repair in the case of an adult hypospadias cripple. Cosmetically, there were two cases with unsightly thickening of the base of the penis in this early series. It was found that this IPSAC procedure had two major advantages: it provided (1) a tension-relieving skin closure, and (2) correction of scrotal deformity, especially in one-stage repair with the parameatal flap and in multi-staged repair with absolute penile skin deficiency.