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Objectives To present a technical tip to be incorporated in the first stage of a 2-stage graft repair of proximal hypospadias associated with curvature, aiming at widening the graft bed and enhancing mobility of the lateral portions of the graft for subsequent urethroplasty. Methods After penile straightening, the dorsal dartos layer, carefully preserved attached to the dorsal penile skin used for penile coverage, is anchored to the lateral edges of the denuded corpora cavernosa with 3 to 4 interrupted 6-0 resorbable stiches on each side. The dartos creates a sort of hammock in-between the corpora, on which the central portion of the graft is quilted as in standard staged graft repair, and the skin margins laterally. Therefore, it widens the graft bed by 3-4 mm on each side. The lateral portions of the graft, laying on dartos, also remain supple for subsequent tabularization. Results Between 2017 and 2019, the technique was used in 16 cases (range 10-19 months). None of these patients required re-grafting because of severe longitudinal graft shrinkage. Conclusion The described modification seems a simple tip to be incorporate in staged graft urethroplasty. Putative advantages include that a wider graft can compensate for some graft shrinkage occurring in-between stages; during the second stage, it can facilitate dissection and improve mobility of the lateral graft portions for tubularization, and make retrieval of a dartos flap for urethroplasty coverage easier. Prospective evaluation and comparative data are needed.

A 12-year-old boy sustained a close-range shotgun wound with buckshot to the penis and lower abdomen. The proximal two-thirds of the corpora cavernosa was obliterated and the distal third was thrombosed. All dorsal penile skin was lost. The urethra remained intact. The patient underwent multiple debridements, allowing the wound to declare its borders. Employing the tissue transfer concept used by Cecil and Culp in hypospadias repairs, the penis was marsupialized onto the suprapubic area where it remained for 8 months. After 8 months, the patient underwent a graft delaying procedure followed by a graft harvest 2 months later and penoplasty tubularization.

Objective To report a modified penoplasty technique for concealed penis in children. Methods Between January 2006 and June 2012, 201 cases of concealed penis were surgically repaired with modified penoplasty. The modified penoplasty technique consisted of 3 major steps: (1) degloved the penile skin and excised the inner prepuce, (2) advanced penoscrotal skin to cover penile shaft, and (3) fixed the penis base and reconstructed the penoscrotal angle. Results Two hundred one cases of concealed penis were enrolled in this study over a period of 6 years. Mean age at the time of surgery was 5.3 years (range 1-13 years) and mean operative time was 40 minutes (range 30-65minutes). All patients were routinely followed up at 1, 3, and 6 months after surgery. Most patients developed postoperative edema and were resolved within 1 month, whereas 20 cases developed prolonged postoperative edema, especially at the site of frenulum, which took 3 months to be resolved. Ten cases had retraction after surgery. No erection difficulties were recorded. Patients/parents reported better hygiene and improved visualization and accessibility of penis after surgery and were satisfied with the cosmetic outcome. Conclusion The result of this study shows that the modified penoplasty technique is a simple, safe, and effective procedure for concealed penis with satisfied cosmetic outcome.

OBJECTIVES Urethral reconstruction in severe hypospadias presents a great challenge. We have designed a method of combining a longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in most severe hypospadias. METHODS Between January 2003 and March 2007, 17 patients (aged from 9 to 23 months) underwent severe hypospadias repair (13 penoscrotal and 4 scrotal hypospadias). Short urethral plate was divided in all cases and remaining curvature repaired by dorsal plication. We harvested and fixed a buccal mucosa graft to the ventral side of corpora cavernosa to be the first half of a neourethra. A longitudinal dorsal island skin flap was created and buttonholed ventrally. We sutured it together with the buccal mucosa graft to form the neourethra. We fixed the abundant flap pedicle laterally to cover all suture lines of the neourethra. We performed penile skin reconstruction using available penile skin. RESULTS The mean (range) follow-up was 25 (7 to 58) months. We achieved satisfactory, functional, and aesthetic results in 14 patients. In 3 cases urethral fistula (2) and distal stricture (1) required secondary treatment. CONCLUSIONS Combined longitudinal island skin flap and buccal mucosa graft could be a good choice for urethral reconstruction in most severe hypospadias repairs.

Introduction Skin grafting of penile defects is difficult because of the flexibility of the underlying recipient bed. This leads to disruption of the vascular ingrowth into the skin graft and compromises the results of the reconstruction. Technical Considerations We successfully used a vacuum-assisted closure dressing with an incorporated wooden framework to secure penile skin grafts in place during the early postoperative period. Conclusions A vacuum-assisted closure dressing can be used successfully to secure large and circumferential skin grafts, as well as skin grafts on concealed penises.

Bladder mucosa grafts were historically used for hypospadias surgical repairs, when preputial or penile skin was unavailable and in cases of prior failed hypospadias repairs. We present a case of advanced penile squamous cell carcinoma diagnosed 22 years after a childhood hypospadias repair with a free bladder mucosa graft.

Introduction Correction of the congenital concealed penis is a difficult surgical challenge. Many techniques have been described for its treatment that differ according to the incision lines and covering techniques, but the results have generally been disappointing. We report a novel surgical technique for unfurling the inner prepuce and outer penile skin and thus obtaining sufficient penile skin coverage. Technical considerations Surgical techniques for correcting the concealed penis are aimed at freeing the penis from any tethering or webbing, providing adequate penile skin coverage and fixing the proximal penile skin to the underlying fascia to prevent the body of the penis from retracting and detaching from its overlying skin. The unfurling method we describe here consists of dividing the outer penile skin to the penile base bilaterally, with ventral and dorsal incisions of the inner prepuce in the midline, perpendicular to the incision of the outer skin. Conclusions This method is simple and provides a good blood supply to the flap. It appears to show good subjective and objective results, and no serious complications have developed.

Objective To describe a new technique to preserve the penile epithelium with good cosmetic results when additional surgery is a significant possibility. Complex genital reconstruction can require multiple procedures. Methods Seven patients underwent grafting of the penile epithelium to the scrotum during genital reconstruction to bank the tissue for potential future use. The graft size was 8-40 mm in the maximal length. Results The median age at surgery was 8.1 months. The median interval to the last follow-up examination after surgery was 13.5 months. All 7 patients demonstrated excellent wound healing with good cosmetic results. Conclusion In patients with complex genital anomalies, nonhair-bearing epithelium is a valuable asset. At times, the paucity of available local tissue necessitates autografting with nongenital epithelium. The need for nongenital tissue can be reduced if excess penile skin is banked for potential use at a later date. We describe a technique in which the penile skin is preserved for potential future reconstruction using free grafting to the scrotum.

In this study, the authors present their experience with preputial mucosal flap usage for reconstruction of full-thickness skin loss of the penis in a patient with scald injury and discuss the possible treatment modalities in penile skin defects. During the 2-year follow-up period, no complication was encountered, and the patient healed uneventfully.

Objective To introduce a new repair technique, inverted V -shape, for penile paraffinoma without necrosis of the ventral skin anastomosed. Materials and Methods From March 2006 to July 2012, 34 patients underwent penile paraffinoma repair using the T -style or a new operation procedure, the inverted V -shape anastomosis with a bilateral scrotal flap. The patients were subdivided into 2 groups. In group 1, each patient underwent the T -style anastomosis. In group 2, each patient underwent the inverted V -shape anastomosis. Two circumferential incisions were made, one at the skin just proximal to the corona of the penis and one at the penoscrotal junction. Complete removal of the involved skin and subcutaneous tissue, including paraffinoma, was performed. Both scrotal flaps were drawn to the mid-dorsal portion of the corona after scrotal flaps were incised appropriately and sutured with a T -style anastomosis between the coronal and scrotal flaps. The ventral skin was anastomosed end to end to avoid the T -style anastomosis, similar to a dorsal anastomosis. We created an inverted V incision 1 cm below from the anastomosis site. The scrotal flaps were sutured layer by layer. Results All 14 flaps survived completely without the necrosis of the ventral skin. The results were successful and without any major complications. Conclusion Penile resurfacing without the T -style anastomosis at the ventral corona with bilateral scrotal flaps is a new technique for repair of penile paraffinoma. It is an effective and reliable method, especially for the saving corona and scrotal flap anastomosed to the ventral penile body.

Objectives. To present our technique and results using a modification of the Cecil-Culp technique of hypospadias repair in a select group of boys with urethrocutaneous fistula during a 6-year period. Urethrocutaneous fistula remains the most common complication of hypospadias repair. Coverage of suture lines with vascularized tissue is thought to decrease fistula formation. Methods. Between 1994 and 1999, 15 boys with hypospadias fistula underwent repair with a modified two-stage Cecil technique. The records were reviewed with respect to age, type of original hypospadias repair, number of previous fistulas, location of the fistulas, and complications. Results. The average age at the time of the first stage of fistula repair was 3.5 years (range 1.8 to 6.0). Five, four, and two patients had undergone one, two, and three previous fistula repairs, respectively. Four boys in this series had deficient penile skin at the time of their first fistula repair. Most had one fistula at the time of the Cecil repair, including eight at the corona, four along the penile shaft, and three in a more proximal location. No patients had a recurrent fistula, with an average follow-up of 21 months (range 1 to 62). Conclusions. Boys with recurrent fistula, despite previous fistula repair, and deficient penile skin present a technical reconstructive challenge. The modified Cecil technique for fistula repair takes advantage of penile mobility to place it in a scrotal location, ensuring excellent vascularized tissue coverage. Although this technique requires a brief second-stage operation, no recurrent fistula has occurred in any of our patients.

The mobilization of penile neurovascular skin flaps is associated with vasospasm, which may result in ischemic necrosis. A prospective clinical trial of nitroglycerin was performed in 40 children undergoing hypospadias repair. Quantitative fluorescein studies were performed in another group of patients who underwent circumcision. These studies represent the first clinical application of nitroglycerin ointment in human subjects. Our preliminary data suggest that nitroglycerin ointment can enhance survival of skin flaps.

We have successfully performed 10 patch graft urethroplasties in adult male rats utilizing non-hairbearing penile skin with microsurgical technique. This model allows us to study the histology of the full thickness patch graft and the effects of various irritants such as contrast material, genitourinary irrigant, urine, and lubricant. We will describe the surgical technique, and representative microsurgical sections of the neourethra will be presented.

A twenty-three-year-old impotence patient is presented who had never achieved penile erection and who suffered megalourethra and megaloureter. Through a penothermocurve the cause of impotence was diagnosed as megalourethra and extensively thickened penile skin. Plastic surgery was performed, and sufficient resection of the enlarged urethral wall and penile skin resulted in successful penile erection and satisfactory intercourse. The usefulness of the penothermocurve was demonstrated as a means for the differential diagnosis of impotence.

The surgical management of a patient with 180-degree penile torsion, balanitic hypospadias, and chordee is presented. Complete resolution of the torsion was effected by completely reflecting the penile skin. Correction of the penile curvature was accomplished simultaneously by freeing the corpora spongiosa from the corpora cavernosa.