Local therapy for penile cancer provides robust survival and can preserve the penis functionally and cosmetically. Interventions must target the appropriate clinical stage. We reviewed studies regarding the primary therapy in penile cancer, from topical therapy to radical penectomy, and reconstructive techniques. Topical therapy (5-FU or Imiquimod) provides a robust oncologic response in patients with Ta or Tis disease. Multiple laser therapies are available for localized patients and those with low-grade T1 disease. There is a non-trivial risk of progression and nodal metastases in poorly selected patients. Wide local excision provides an oncologically sound option in patient with up to T1 disease; less evidence exists for Mohs microsurgery in the setting of penile cancer. Increasingly aggressive approaches include glansectomy and partial/radical penectomy, which provide 5- and 10-year cancer-specific survival rates of over 80%. Meticulous reconstruction is necessary for the durable function of the remaining penis. Preservation of voiding and sexual function occurs via penile skin grafting, glans resurfacing, creation of a functional penile stump, and phalloplasty with a penile implant. Perineal urethrostomy provides an alternative in pathology demanding extensive partial or radical penectomy, and a durable option for seated voiding. Clinical suspicion and timely diagnosis are paramount in terms of management as less-invasive options for earlier-stage disease develop.

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

BACKGROUND: Penile amputation is an unusual situation reported globally as isolated cases and small series. It constitutes a urological emergency which requires microsurgical skills for the repair of the penis. We present a case of a penile amputation and discuss the management of this challenging condition.
METHODS: A 47-year-old patient presented to the emergency room with total amputation of corpora cavernosa of the penis resulting from knife aggression. The patient underwent successful microsurgical replantation, demonstrating positive progression and satisfactory results.
UNASSIGNED: Microneurovascular repair of penile amputation is the gold standard. Recommendations include a meticulous anastomosis, and a focus on vein anastomoses for optimal outcomes as well as associating a psychiatric approach. The PENIS score classifies the severity of lesion and predict postoperative complications and main outcomes.
CONCLUSIONS: Penile amputation presents a distinctive challenge, necessitating microsurgical anastomosis, meticulous tissue management, and adherence to established protocols are imperative for effectively managing such intricate cases. Even in cases of posttraumatic partial penile amputation after a long period, can yield satisfactory morphofunctional outcomes.

Objective We aimed to evaluate both the long-term surgical outcomes and patient-reported outcomes of free scapular flap (FSF) phalloplasty. Method The same surgical team performed phalloplasty in 66 patients using a FSF between March 2000 and September 2018. All patients had at least 24 months of follow-up. The surgical techniques used, complications observed, and surgical and patient-reported outcomes were retrospectively described. Results A total of 66 patients with indications of penile trauma (n = 19), micropenis (n = 42), and self-amputation (n = 5) underwent FSF phalloplasty. Two patients (3%) had total flap necrosis and 1 (1.5%) had partial flap necrosis. The urethral complication rate was 18.2% (12/66 patients). All patients were able to void while standing after revision procedures or urethroplasty. We found that an FSF is a reliable donor site for penile reconstruction. Conclusion The FSF phalloplasty creates an esthetically pleasing penis and allows voiding while standing. Most patients can engage in sexual activity. The main drawbacks of using this method are that patients experience different degrees of sensory recovery, and patients undergoing surgery with the \"tube-in-tube\" technique may find they are be limited by the thickness of the flap. However, by making full use of residual tissue, such as the micropenis glans or scrotal skin, patients can obtain good tactile and erogenous sensation. We believe that using an FSF complements the existing phalloplasty techniques.
RésuméObjectif Les chercheurs ont voulu évaluer les résultats chirurgicaux à long terme et les résultats cliniques déclarés par les patients d’une phalloplastie par lambeau scapulaire libre (LSL). Méthodologie La même équipe chirurgicale a effectué la phalloplastie de 66 patients au moyen d’un LSL entre mars 2000 et septembre 2018. Ceux-ci ont tous reçu un suivi d’au moins 24 mois. Les chercheurs ont décrit rétrospectivement les techniques chirurgicales utilisés, les complications observées et les résultats chirurgicaux et cliniques déclarés par les patients. Résultat Au total, 66 patients ayant des indications de traumatisme pénien (n=19), un micropénis (n=42) et une auto-amputation (n=5) ont subi une phalloplastie par LSL. Deux patients (3 %) ont subi une nécrose totale du lambeau et un (1,5 %) une nécrose partielle du lambeau. Le taux de complications urétrales s’est élevé à 18,2 % (12 patients sur 66). Tous les patients étaient en mesure d’uriner debout après les interventions de révision ou l’urétroplastie. Les chercheurs ont constaté que la région scapulaire est un siège de donneur fiable pour la reconstruction pénienne. Conclusion La phalloplastie par LSL crée un pénis à l’esthétique agréable, qui permet d’uriner debout. La plupart des patients peuvent se livrer à des activités sexuelles. Les principaux inconvénients de cette méthode proviennent du fait que les patients éprouvent divers degrés de récupération sensorielle et que ceux qui subissent la technique chirurgicale « à double tube » peuvent être limités par l’épaisseur du lambeau. Cependant, grâce au plein usage des tissus résiduels, tels que le gland du micropénis ou la peau du scrotum, les patients peuvent éprouver de bonnes sensations tactiles et érogènes. Les auteurs sont d’avis que l’utilisation du LSL complète les techniques de phalloplastie en place.

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OBJECTIVE: Circumcision is one of the most frequently performed surgical procedures. Complications are infrequent, including bleeding, though can be significant such as shaft skin excision. The aim of this study was to identify mechanism of injury and reconstructive techniques for skin excision using a full thickness skin graft (FTSG) or with the novel application of tissue expanders (TE).
METHODS: Patients who underwent penile reconstruction following shaft skin excision from an overzealous circumcision were retrospectively reviewed. The penis was covered using a FTSG, harvested from the groin/hip, or using TE, with expanders placed in residual shaft skin.
RESULTS: Twelve patients experienced significant skin loss (range 65-95%) including 2 with partial glans loss. Ten were reconstructed using a FTSG and 2 with TE. Injury was most frequently from a Mogen clamp (n = 9), or from a Gomco clamp, Plastibell device, and electrocautery burns. Six FTSG patients experienced complications with lymphedema (n = 3) most common.
CONCLUSIONS: Shaft skin excision is a devastating complication with risk greatest from Mogen clamp use. TE is preferred as this avoids donor site morbidity which reassures parents but requires sufficient residual skin that can be expanded. Both techniques effectively provide soft tissue coverage with acceptable appearance and long-term function.

UNASSIGNED: Peyronie\'s disease is the disease that results in an alteration in the curvature of the penis, which can lead to a shortening of length, pain in erection, or difficulties in penetration, thus leading the patient to psychological alterations due to loss of functionality such as aesthetic alteration. That is why there are several studies to define the best form of treatment, which currently continues to be the first choice surgical treatment.
UNASSIGNED: We present the most recommended therapies for Peyronie\'s disease and suggest an algorithm as a guide to direct therapy.
UNASSIGNED: We used the PubMed platform to review the literature related to Peyronie\'s disease. Various editorials were reviewed as well as original articles and reviews focusing on the various treatments as well as their indications and results.
UNASSIGNED: Peyronie\'s disease in which conservative or drug treatment does not have a response, surgical treatment with corporoplasty, penile prosthesis implantation or both may be indicated. Corporoplasty refers to both the plication of the tunica albuginea as well as the incision of the tunica with the placement of a graft. An accurate history should always be carried out to identify erectile dysfunction as well as to be able to guide you on the repercussions of the treatment. If refractory erectile dysfunction is present, placement of a penile prosthesis with or without further adjunctive straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and results of the available techniques, and proposed a surgical treatment algorithm.
UNASSIGNED: Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient\'s erectile function is adequate. The presence of \"borderline\" erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. An accurate risk/benefit assessment of the individual patient as well as meticulous patient counseling are critically important.

Background. Surgical procedures for squamous cell carcinoma of the penis generally involve primary closure, partial glansectomy, skin graft, and penile amputation. Partial penile resection can result in not only unsightly deformation of the penis but also functional disorders of the urinary line as well as psychological effects due to subjective perceptions of a loss of power and masculinity. With the use of an organ-preserving procedure for functional reconstruction without compromising oncological control, this report describes a new procedure for performing functional penile reconstruction with an auricular cartilage composite graft.

Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced. We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.

UNASSIGNED: : To review the literature on adult penile reconstruction due to Peyronie\'s disease, trauma and cosmesis, while emphasising specific surgical techniques and procedures such as phalloplasty, radial forearm free flap reconstruction, and penile transplant.
UNASSIGNED: : A comprehensive review of the literature for the years 1992-2020 of the PubMed and SpringerLink databases was performed to identify articles on penile reconstruction. Search terms included \'penile reconstruction\', \'penile trauma\', \'phalloplasty\', \'penile transplant\', and \'treatment of Peyronie\'s\'. Relevant articles were selected. All included studies were performed on adults and written in English.
UNASSIGNED: : We were able to identify 46 papers from PubMed and SpringerLink that included the research terms. From these, we included technical details of procedures and gleaned photographs of their works. Additionally, we included photographs from our institution\'s own plication surgery cases.
UNASSIGNED: : The field of adult penile reconstruction is performed for a plethora of reasons. From cosmetic to urgent and from routine to complex, it is most certainly a growing subset of Urology that plays a vital role for the men who need it. To our knowledge, this is the most up-to-date review of adult penile reconstruction.