Aesthetic neo-glans reconstruction after penis-sparing surgery for benign, premalignant or malignant penile lesions

Abstract

PurposeTo describe the technique and results of penis-sparing surgery combined with a cosmetic neo-glans reconstruction for benign, pre-malignant or malignant penile lesions.Patients and methodsTwenty-one patients (mean age 61 years) with penile lesions with a broad spectrum of histopathology underwent organ-sparing surgery with neo-glans reconstruction, using a free split-thickness skin graft harvested from the thigh. Three patients were treated by glans-skinning and glans-resurfacing, 10 by glansectomy and neo-glans reconstruction, four by partial penectomy and a neo-glans reconstruction, and four by neo-glans reconstruction after a traditional partial penectomy.ResultsThe mean follow-up was 45 months; all patients were free of primary local disease. All patients were satisfied with the appearance of the penis after surgery, and recovered their sexual ability, although sensitivity was reduced as a consequence of glans/penile amputation.ConclusionIn benign, premalignant or malignant penile lesions, penis-sparing surgery combined with a cosmetic neo-glans reconstruction can be used to assure a normally appearing and functional penis, while fully eradicating the primary local disease.

Recent advances in understanding and managing Lichen Sclerosus

“…Glans resurfacing is indicated in severe LS 47 ; it involves a circumcision and the removal of the penile glandular epithelium. A free split-thickness skin graft then can be harvested from the thigh and transplanted over the glans while using interrupted sutures throughout 48 . Palminteri et al…”

Functional and Patient Reported Outcomes Following Total Glans Resurfacing

“…10,13,,20,24,29-30 Their major advantage arises with their ability to minimize cosmetic, sexual and functional drawbacks that characterized the more radical approaches (total or partial penectomy). [3][4]10,24,30 A referral center specializing in the management of benign, premalignant and malignant penile lesions should provide patients with a spectrum of treatment options, dependent upon patient and clinical variables. Whilst data regarding surgical outcomes of the different organ sparing techniques are limited, the evidence is even more sparce for functional outcomes and patient satisfaction, following penile preservation procedures.…”

“…6 Some authors have reported satisfactory and excellent TGR outcomes from a functional and sexual point of view, without however having applied any validated scoring tools. [3][4][5]30 Several studies have evaluated patient erectile function via the administration of validated questionnaire (IIEF-5) and/or open questions regarding penile sensation and orgasmic function. 2,[6][7] Hadway et al 2 and O'Kelly 7 reported a IIEF-5 postoperative median score of 24 and 22, respectively.…”

“…Total glans resurfacing (TGR) is an organ preserving surgical technique which was described approximately 15 years ago for the management of benign, premalignant or malignant penile conditions. [1][2][3][4][5][6][7] In 2011, Shabbir et al described partial glans resurfacing (PGR) too. PGR was considered adequate for single benign or malignant lesions involving less than 50% of the glans.…”

“…[8][9][10][11][12] This has been progressively come out of favour. 4,10,[13][14] To minimize the negative impact upon patient quality of life and sexual function, [15][16][17] selected lesions are now managed with penile sparing techniques, whilst aiming to maintain oncological outcomes. 2,3,5,7,11,[15][16][17][18][19][20] Available data supporting these conservative approaches are somewhat limited, considering PC is a rare disease affecting less than 1/100000 men per year in Western countries and representing up to 1% of male cancers worldwide.…”