Evaluation of Z-plasty versus Heineke-Mikulicz scrotoplasty in the management of penoscrotal web in pediatric age group

BACKGROUND

The penoscrotal web may be congenital or acquired following excessive ventral skin removal during circumcision. Several surgical techniques were described for the treatment of congenital webbed penis without a clear comparison between their outcomes. This prospective study aimed at comparing the surgical results of Z-scrotoplasty and Heineke-Mikulicz scrotoplasty in the treatment of congenital webbed penis in uncircumcised pediatric patients.

METHODS

Our study included 40 uncircumcised patients who were divided randomly into two groups; Group A included 20 patients who were treated by Z-scrotoplasty and Group B included the other 20 patients who were treated by Heineke-Mikulicz scrotoplasty. All patients were circumcised at the end of the procedure.

RESULTS

The surgical outcome was good without a significant difference between the two groups in 36 patients. Recurrent webbing developed in one patient of Group A and in three patients of Group B (FE p = 0.605) The only significant difference between the two groups was the operative duration which was shorter in Group B than in Group A (P < 0.001*).

CONCLUSIONS

Treatment of congenital penoscrotal web in the pediatric age group could be done with either Z-scrotoplasty or Heineke-Mikulicz scrotoplasty with satisfactory results, however, without significant difference in the surgical outcomes.

TRIAL REGISTRATION

• Registration Number: ClinicalTrials.gov ID: NCT05817760. • Registration release date: April 5, 2023.

Surgical management of acquired buried penis and scrotal lymphedema: A retrospective review

Acquired buried penis is a condition that can have detrimental physical and psychological consequences for patients. Factors such as elevated BMI, chronic scrotal lymphedema, hidradenitis suppurativa, and chronic inflammation can lead to the condition. Surgical intervention is the treatment of choice for advanced disease. Following IRB approval, a retrospective chart review was performed for patients with a diagnosis of acquired buried penis who required surgical intervention. Details of patient history, surgical management including intraoperative and post-operative photography, and complications were reviewed. Seven patient cases were reviewed. The average age at time of surgery was 44 with a mean weight of 344 pounds and an average BMI of 48. Severe scrotal lymphedema and hidradenitis were common concurrent comorbidities. Concurrent scrotoplasty and infraumbilical panniculectomy were standard parts of the operations. Native glans skin was salvageable in all but one case. Penile shaft skin was reconstructed with skin grafts or adjacent tissue transfer. 88% of the cases had some element of wound dehiscence post-operatively. Surgical management of an acquired buried penis can be challenging. The patient demographic with the disease is frequently complicated by morbid obesity, concurrent lymphedema, or hidradenitis. Post-operative complications are expected. The surgical techniques presented can aid in simplifying the management of this challenging surgical population.

Giant scrotal lymphedema after paraffinoma injection: A case report

Scrotal lymphedema is a rare condition characterized by blocked lymphatic drainage to the scrotum, resulting in physical and psychological discomfort for sufferers. Here, we present a case study of a 27-year-old male with giant scrotal lymphedema resulting from paraffinoma injection. The patient experienced scrotal enlargement since 2019, which engulfed the penis and was surrounded by edema. After confirming the absence of filariasis parasites, the patient underwent paraffinoma excision and scrotoplasty, resulting in a 13 kilograms scrotal specimen with no signs of malignancy. Giant scrotal lymphedema can be distressing, but surgical excision can improve the patient's quality of life.

Unilateral Suprainguinal Ectopic Scrotum: Case Report and Literature Review

Ectopic scrotum is an infrequent congenital scrotal anomaly. Different surgical methods of correcting ectopic scrotum have been used, but none have produced optimal cosmetic results for all types. We describe a case of left ectopic suprainguinal scrotum in a 14-month-old boy who had an undescended left testicle and a left-sided scrotal skin tag. Single-stage rotational flap scrotoplasty and unilateral orchiopexy were performed; however, we modified the surgical technique of scrotal rotation by excising the intervening longitudinal skin. Eight months after surgery, the repositioned scrotum had a better appearance, and the affected testicle was similar in size to the contralateral one. In comparison with other surgical methods, pedicle flap rotation of the ectopic scrotal skin with excision of the intervening longitudinal skin may produce a better cosmetic outcome.

Varicocele indicated scrotoplasty with varicocelectomy: A case report

A 72 -year- old male patient presented to the clinic complaining of mild dragging scrotal pain and hanging scrotum interfering with his daily activity. Clinical examination revealed grade three left varicocele, enlarged hanging scrotum for more than 15 cm from the scrotal neck. The scrotum was explored and left varicocelectomy was done then scrotoplasty. Fifteen months post-operatively patient has an excellent outcome.

Giant scrotal swelling in association with a congenital giant melanocytic nevus: A case report

Introduction

Scrotal lymphedema is a rare condition, with significant psychological and functional disability. To date, association with giant congenital melanocytic nevus has not been reported.

Case report

We report a case of a 15-year-old male with a giant congenital nevus associated with giant scrotal lymphedema. Surgical debulking with penoscrotoplasty achieved satisfactory functional and esthetic results.

Conclusions

Early diagnosis and surgical intervention should be advocated for congenital causes of large scrotal swelling.

Surgical Outcomes of Neoscrotal Augmentation with Testicular Prostheses in Transgender Men

INTRODUCTION

Testicular prosthesis implantation may be used for neoscrotal augmentation in transgender men.

AIM

Assess the clinical outcomes and risk factors for postoperative complications of this procedure in transgender men.

METHODS

All transgender men who underwent neoscrotal augmentation with testicular implants between January 1992 and December 2018 were retrospectively identified. A retrospective chart study was performed that recorded surgical characteristics and postoperative complications. Risk factors on complications were identified using uni- and multivariate analyses.

MAIN OUTCOME MEASURE

Surgical outcomes included explantation due to infection, extrusion, discomfort, or leakage.

RESULTS

We identified 206 patients, and the following prostheses were placed: Dow Corning (n = 22), Eurosilicone (n = 2), Nagor (n = 205), Polytech (n = 10), Promedon (n = 105) , Prometel (n = 22), Sebbin (n = 44), and unknown (n = 2). The mean clinical follow-up time was 11.5 ± 8.3 years. In 43 patients (20.8%), one or both prostheses were explanted due to infection, extrusion, discomfort, prosthesis leakage, or urethral problems. Currently, scrotoplasty according to Hoebeke is the most frequently performed technique. Our review found that for this technique explantation occurred in 6 of 52 patients (11.5%). A history of smoking was a risk factor for postoperative infections and prosthesis explantation. In earlier years, larger prostheses were immediately placed at scrotal reconstruction; however, a trend can be seen toward smaller and lighter testicular prostheses and delayed implantation.

CLINICAL IMPLICATIONS

Patients wanting to undergo this procedure can be adequately informed on postoperative outcomes.

STRENGTHS & LIMITATIONS

Strengths of this study include the number of patients, long clinical follow-up time, and completeness of data. Weaknesses of this study include its retrospective nature and the high variability of prostheses and surgical techniques used.

CONCLUSION

Over the years, scrotoplasty techniques and testicular prostheses preferences have changed. Explantation rates have dropped over the last decade. Pigot GLS, Al-Tamimi M, Ronkes B, et al. Surgical Outcomes of Neoscrotal Augmentation with Testicular Prostheses in Transgender Men. J Sex Med 2019;16:1664-1671.

One stage rotation flap scrotoplasty and orchidopexy for the correction of ectopic scrotum: A case report

Ectopic scrotum (ES) is a particularly rare congenital malformation of the scrotum and commonly associated with other congenital malformations. A 2-year-old boy was presented with ectopic scrotum, low lesion imperforate anus, spina bifida and pubic diastasis since birth. There are various surgical methods available to be discussed in the management of ES. We performed correction of the ectopic scrotum and concomitant bilateral orchidopexy in one stage of surgery. This procedure is relatively simpler to perform and gives out favorable cosmetic result.

Surgical management of giant scrotal lymphedema in morbidly obese patient with trisomy 21

Huge scrotal lymphedema is a rare problem that affects the patient's lifestyle and leads to physical and emotional disability. It also carries potential challenges for the treating surgeon, especially if the patient is noncompliant or morbidly obese. A 21-year-old morbidly obese trisomy 21 man with huge scrotal lymphedema and buried penis that developed within 2 years presented for excision scrotoplasty with reconstruction of the penis using the original invaginated penile skin. Giant scrotal lymphedema with buried penis can be treated successfully by excision scrotoplasty with preservation of the invaginated healthy penile skin to reconstruct the penis.

SCROTAL SQUAMOUS CELL CARCINOMA AND ASSOCIATED BLINDNESS: A CASE REPORT AND LITERATURE REVIEW

BACKGROUND

Carcinoma of the scrotum is a rare disease which has been linked with occupational exposure to certain industrial carcinogens. Scanty reports of scrotal carcinoma exist in literature but in very few places worldwide. To our knowledge, there has been one documented report of scrotal carcinoma in our country and this is the first report of scrotal carcinoma in over 45years existence of our tertiary Health institution. We present the clinical evaluation, investigations and surgical intervention of a blind elderly welder with squamous cell carcinoma of the scrotum at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.

CASE PRESENTATION AND MANAGEMENT

A 65 year-old blind welder presented to us with a painless fungating scrotal mass of two years' duration. He had prior incision and drainage of the swelling in a primary health centre but this failed to heal, with copious purulent discharge. The mass measured 20cm x 15cm x 8cm and was inseparable from the right testis and cord structures, with infiltration of the root of the penis. The inguinal lymph nodes were not enlarged. CT scan confirmed localized scrotal tumour and biopsy confirmed squamous cell carcinoma.He subsequently had wide local excision of the scrotal tumour (with at least 2cm free margins), right total orchidectomy and advancement flap closure of scrotal defect. Histopathological reports corroborated the earlier findings and confirmed tumour free margins. He has remained well 18 months after surgery.

CONCLUSION

Squamous cell carcinoma of the scrotum, though rare, is the commonest malignancy affecting the scrotum worldwide. Surgery still remains the mainstay of treatment and early intervention improves the chances of a favourable outcome.

Correction of congenital penoscrotal webbing in children: A retrospective review of three surgical techniques

INTRODUCTION

Congenital penoscrotal webbing (PSW) is a condition that leads to penile shortening and is a common cause of delayed circumcision. While various techniques for PSW repair have been described, no comparative studies are currently available.

OBJECTIVE

The goal of this study was to validate and critique three commonly utilized techniques for PSW repair.

SUBJECTS AND METHODS

A retrospective chart review was performed on all patients who underwent repair for PSW, with or without concomitant surgical procedure, by a single surgeon (MKH) over a 7-year period. Inclusion criteria were: aged <5 years, diagnosis of PSW, documented surgical approach undertaken to correct the PSW, and follow-up for a minimum of 6 months. A total of 196 patients aged 6 months-3.4 years (average 7.8 months) were included, and underwent three different types of procedure: Heineke-Mikulicz (HM) scrotoplasty, VY scrotoplasty or Z scrotoplasty.

RESULTS

Out of 196 patients, 10 (6.7%) had complications, with four (2.7%) requiring surgical revision or correction. Two patients had excision of 'dog-ear' skin tags, one required excision of a suture tract, and the fourth required revision of skin contraction after HM repair with Z scrotoplasty.

DISCUSSION

Congenital penoscrotal webbing is a common condition that often requires pediatric urology consultation. Although it is felt that the severity of the defect may not impact on the operative technique for repair of PSW, data comparing these techniques is lacking. This single-surgeon series highlighted that amongst the patients who underwent one of the three described techniques (HM, VY or Z scrotoplasty), there were no significant postoperative differences in complications or parent satisfaction. Although the ease of the HM repair for minor webbing is acknowledged, Z scrotoplasty is the authors' preference for repair given its ability to address the most severe webbing.

CONCLUSIONS

In this comparison of three surgical techniques for the correction of PSW, it was demonstrated that each choice is safe, with no option showing a significant difference in complication rate. Surgeon preference should therefore weigh heavily when choosing the surgical approach for PSW repair.

Reconstructive surgery for giant penoscrotal elephantiasis: about one case

Elephantiasis of the external genitalia is characterized by lymphedema and thickening of the subcutaneous tissues. This gives the skin an appearance similar to a pachyderm skin. This pathology is invalidating for the patient. Reconstructive surgery is often the only way to restaure aesthetic and functional aspects of the external genitalia. We aim to report a 52 year man with huge penoscrotal elephantiasis who underwent excision and penoscrotal reconstruction at the department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou.

Penile reconstruction in the male

We describe and review the most recent techniques of male genital reconstruction, identifying relevant material with an unstructured PubMed-based search of previous reports, using the keywords ‘reconstruction’, ‘glans’, ‘shaft’, ‘lymphoedema’, ‘skin graft’, ‘scrotoplasty’, ‘urethroplasty’, and ‘penile prosthesis’. This search produced 22 reports that were analysed in this review. Split-thickness skin grafts are ideal for glans reconstruction, while full-thickness skin grafts should be used to cover defects on the shaft penis, as they tend to heal with less contracture. The radial artery-based free-flap phalloplasty is the technique of total phallic reconstruction associated with the highest satisfaction rates. Further research is required to identify an ideal reconstructive technique that would guarantee superior cosmetic and functional results, minimising donor site morbidity.