Reconstruction of Penis
Penile Reconstruction Following Gas Gangrene
A case report of a diabetic male who suffered from gas gangrene following urethral instrumentation underwent reconstructive procedure using local tissue flap. A 40 years old diabetic man underwent cystolithotripsy for a vesical calculus in a suburban nursing home. After removal of catheter he failed to pass urine and needed an indwelling catheter. Reinsertion of catheter could be possible only after the dilatation of urethra using a metal bougie. The patient developed fever and swelling of the external genitalia. At this stage he was referred to tertiary care center. On arrival in the emergency ward, he had clinical features of septicemia; diffuse swelling of external genitalia extending up to the lower abdomen. Subcutaneous crepitus was appreciated over the lower abdomen. A Computerized Tomography scan confirmed gas in the subcutaneous space, corpora cavernosal and corpus spongeosum. He was treated with broad-spectrum antibiotics, debridement and suprapubic diversion of urine. At a later date the left corpus cavernosum was excised and urethra was laid open. Once the sepsis was controlled, penis was reconstructed using a rotation flap using scrotal skin based on dartos fascia.
A cosmetically acceptable penis with urethral continuity was attained. This case highlights the complication of a relatively simple procedure resulting in a life threatening condition. Local tissue flap has been used restore the continuity of urethra and external appearance.
Reconstruction of Penis Following Cancer
This is the story of a 30 year old married man who underwent complete removal of his penis 3 years ago for cancer. At that time the cancer had spread to regional lymph nodes and all these extensions of disease were removed surgically during a tedious operation. He later received radiotherapy for the same. After observing for 3 years, when there was no detectable trace of cancer, I decided to reconstruct the penis.
Usually in a situation like this, standard plastic surgery techniques involve reconstruction of phallus by using a free flap transfer of skin and tissues from fore arm. The major disadvantage of this technique is that even though one can form an organ, it usually lacks sensation. Moreover, since it is limp, it cannot perform sexual activity.
Since our patient was young and wished to regain sexual function, it was planned to reconstruct his organ using local tissues in order to preserve sensation and incorporate semi rigid implant to provide rigidity.
After meticulous planning, he underwent a four hour long procedure under general anaesthesia. Socks made up of Nylon mesh were fabricated to house the semi rigid implants. These were then anchored to the bone at the same location where the original penile shafts are anchored. Local tissues were used to give an external appearance of penis. He withstood the procedure well and should be able to have a satisfactory intercourse which would be allowed at the end of three months. However the best person to certify that would be his partner (wife in this case).