Optimizing Penile Length in Patients Undergoing Partial Penectomy for Penile Cancer: Novel Application of the Ventral Phalloplasty Oncoplastic Technique

Abstract

_______________________________________________________________________________________The ventral phalloplasty (VP) has been well described in modern day penile prosthesis surgery. The main objectives of this maneuver are to increase perceived length and patient satisfaction and to counteract the natural 1-2 cm average loss in length when performing implantation of an inflatable penile prosthesis. Similarly, this video represents a new adaptation for partial penectomy patients. One can only hope that the addition of the VP for partial penectomy patients with good erectile function will increase their quality of life. The patient in this video is a 56-year-old male who presented with a 4.0x3.5x1.0 cm, pathologic stage T2 squamous cell carcinoma of the glans penis. After partial penectomy with VP and inguinal lymph node dissection, pathological specimen revealed negative margins, 3/5 right superficial nodes and 1/5 left superficial nodes positive for malignancy. The patient has been recommended post-operative systemic chemotherapy (with external beam radiotherapy) based on the multiple node positivity and presence of extranodal extension. The patient's pre-operative penile length was 9.5 cm, and after partial penectomy with VP, penile length is 7 cm. ARTICLE INfO

Mystery and realities of phalloplasty: a systematic review

“…[37][38][39][40] Also there are some techniques used for penile lengthening such as suspensory ligament release, augmentation corporoplasty, ventral phalloplasty, and suprapubic lipectomy, monsplasty. [41] Ventral phalloplasty would be used for penile lengthening with or after partial penectomy as Wallen et al [42] reported good results. Aphallia is a rare congenital defect with the ratio of 1/30 million births.…”

Penile Sparing Techniques For Penile Cancer

“…The penile stump can then be anchored to the pubic bone to prevent retraction [79]. While initially used to increase perceived penile length in patients undergoing penile implants, Wallen et al [80] incorporated the ventral phalloplasty technique after partial penectomy. A transverse 'V'-shaped excision at the penoscrotal junction is made and the wound is then closed in a longitudinal fashion to improve penile cosmesis.…”

Penile sparing surgical approaches for primary penile tumors: preserving function and appearance

“…One documented means of improved functional outcomes comes from literature by Wallen et al in describing the ventral phalloplasty for optimizing penile length following partial penectomy. The average loss of 1–2 cm following partial penectomy causes significant emotional distress in patients and may be minimized by performing a ventral phalloplasty in patients undergoing surgical resection ( 78 ). The procedure offers a simple adaptation that can add to patient satisfaction and be performed at that time of the original cancer operation.…”