ESPU Congress 2017 - Abstract book

CONGRESS OF THE ESPU

MATERIAL AND METHODS

Four years old boy was referred to our center for management of total necrosis (Phallus, penile

skin, and urethra) after neonatal total reconstruction of bladder exstrophy. Clinically he had opened

incontinent bladder without bladder neck, normal scrotum. He had only part of his crura left at-

tached to the pelvic ring. We have scheduled multi-staged reconstruction. First surgery was bladder

augmentation, bladder neck closure and Mitrofanoff, and mobilization of the corpus cavernosa crura

to bring them to the perineum. After full healing, and on the demand of the child to have any penile

structure. At 6 years old, We started a multi staged penile reconstruction. Parascrotal flaps were

prepared after insertion of expanders. The flaps were used to reconstruct a new phallus around

the 2 cm residual of the crura. After early satisfying results, the empty flaps shrunken and the crura

retracted with bad cosmetic aspect. We have used a personalized tailored, semi-rigid prosthesis

and inserted this prosthesis inside the flaps

RESULTS

One year follow up, the skin of the phaloplasty remains well vascularized without erosion, the

7 years old child express very clearly his satisfaction on having a “penile” structure. He is using CIC

through the neo umbilicus.

CONCLUSIONS

We describe a preliminary result of new strategy to temporary manage the total penile loss after

bladder exstrophy surgery. Certainly this temporary prosthesis will need to be replaced by functional

adult-type prosthesis later on.

15:43–15:45

S3-5 (CP)

RECONSTRUCTION OF IATROGENIC TRAPPED PENIS

AFTER RADICAL CIRCUMCISION

Miroslav DJORDJEVIC

, Vladimir KOJOVIC

, Marta BIZIC

and Borko STOJANOVIC

1) University Children’s Hospital Belgrade, Paediatric Surgery/Urology, Belgrade, SERBIA - 2) School of Medicine,

University of Belgrade, Serbia, Pediatric Urology, Belgrade, SERBIA

PURPOSE

Trapped penis after radical circumcision is associated with severe functional, esthetic and psy-

chological consequences. Severe lack of penile skin makes this condition very challenging for

reconstruction. We have analyzed outcomes of trapped penis repair using genital skin flaps.

MATERIAL AND METHODS

From January 2006 to March 2016, 22 patients, aged 15 to 21 years, underwent genital reconstruc-

tion after previously performed radical circumcision. Artificial erection was used for intraoperative

assessment of skin defect and creation of properly fashioned genital flaps. After releasing of penile

shaft, vascularized flaps are designed and harvested from scrotal skin to cover the defect. Proximal

part of cavernosal bodies is fixed to the skin by U-shape suture in order to prevent postoperative

retraction of the penis. Vacuum device is used for six months, starting four weeks after surgery.

RESULTS

Follow up ranged from 6 to 130 months (mean 62 months). Size of the skin defect was from 2 to

10 cm in erect state. Good cosmetic and functional outcome was achieved in 19 patients, while in

remaining three cases additional corrections were needed.

CONCLUSIONS

Radical circumcision, especially in cases with associated anomalies of penile skin (concealed

penis, webbed penis), leads to iatrogenic trapped penis. Versatile vascularized scrotal skin flaps

can be successfully used for the reconstruction of the penile shaft.