RECONSTRUCTIVE UROLOGY

Resurfacing and reconstruction of the glans penis
Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G
Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy
Eur Urol. 2007; 52: 893-8

• Objectives: To describe the techniques and results of surgical reconstruction of glans penis lesions.
• Methods: Seventeen patients (mean age: 53.2 yr) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was one Zoon’s balanitis, four lichen sclerosus, one carcinoma in situ, five squamous cell carcinomas, and six squamous cell carcinomas associated with lichen sclerosus. Five cases were treated by glans skinning and resurfacing; five cases by glans amputation and reconstruction of the neoglans, and seven cases by partial penile amputation and reconstruction of the neoglans. Glans resurfacing and reconstruction were performed with the use of a skin graft harvested from the thigh.
• Results: The mean follow-up was 32 mo. All patients were free of local premalignant/malignant recurrence. Patients who underwent glans resurfacing reported glandular sensory restoration and complete sexual ability. Patients who underwent glansectomy or partial penectomy with neoglans reconstruction maintained sexual function and activity, although sensitivity was reduced as a consequence of glans/penile amputation.
• Conclusions: In selected cases of benign, premalignant or malignant penile lesions, glans resurfacing or reconstruction can ensure a normal appearing and functional penis, without jeopardizing cancer control.
  

• Editorial Comment
  Reasons for penile reconstruction may not only be neoplasia, but also trauma, inflammatory disease and congenital malformation. In many cases, careless even unnecessary amputations eliminate the possibility for a satisfactory glans reconstruction. Because penile anatomic reconstruction is often possible, the EAU has established treatment guidelines on penile cancer (1) which favor the use of conservative penile sparing techniques for the tumor entities of Ta-T1, G1-3 and select cases of T2 tumors.
  Palmintteri et al. and Gulino et al. published their techniques, which appear to help in the reconstruction of the penile glans with a good cosmetic outcome (2,3). Palminteri et al. used a free split-thickness skin graft of the thigh. Gulino et al. investigated their functional outcome even further after using the distal urethra in the reconstructive approach. With a physical examination, the IIEF (erection, ejaculation, orgasm and libido domain score) and the Bigelow & Young scores, they evaluated an overall satisfying outcome with a minor additional surgical effort (mean 35 min). The advantage of using the distal urethra is the untroubled blood supply (including certain rigidity under erection) and the sensibility.
  Both techniques can be performed for a distal penile reconstruction involving amputation up to one third of the penile length. In case of penile cancer, both oncological radicality and satisfactory body image can be achieved. It complies with compliance of EAU penile cancer guidelines and maximizes patients´ quality of life without compromising tumor survival.

References
1. Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T; European Association of Urology: EAU Guidelines on Penile Cancer. Eur Urol. 2004; 46:1-8.
2. Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G: Resurfacing and reconstruction of the glans penis. Eur Urol. 2007; 52: 893-8.
3. Gulino G, Sasso F, Falabella R, Bassi PF: Distal urethral reconstruction of the glans for penile carcinoma: results of a novel technique at 1-year of followup. J Urol. 2007; 178: 941-4.

Dr. Karl-Dietrich Sievert &
Dr. Arnulf Stenzl
Department of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany