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Review
. 2019 Jun 9:2019:5219048.
doi: 10.1155/2019/5219048. eCollection 2019.

Glans Resurfacing with Skin Graft for Penile Cancer: A Step-by-Step Video Presentation of the Technique and Review of the Literature

Athanasios Pappas  1 , Ioannis Katafigiotis  2 , Marjan Waterloos  3 , Anne-Francoise Spinoit  3 , Achilles Ploumidis  1
Affiliations
Review

Glans Resurfacing with Skin Graft for Penile Cancer: A Step-by-Step Video Presentation of the Technique and Review of the Literature

Athanasios Pappas et al. Biomed Res Int. .

Abstract

Introduction: Glans resurfacing has been suggested as a treatment option for the surgical management of superficial penile cancer (Tis, Ta, T1aG1, T1aG2). In this article we describe in detail the glans resurfacing technique with skin graft for penile cancer in a video presentation and we review the current knowledge of the literature.

Material and methods: The procedure is described in a stepwise fashion. Initially the patient is circumcised. The glans is marked in quadrants and completely stripped by dissecting and removing the epithelium and subepithelium layer of the glans. Deep spongiosal biopsies are taken to exclude invasion. Each quadrant is sent separately for biopsy. The surface of the graft size needed is estimated. A partial thickness skin graft is harvested from the thigh with a dermatome. The skin graft is then fenestrated. The graft is rolled over the glans and quilted with multiple sutures. A silicone 16F Foley catheter and a suprapubic catheter are placed. The penis is dressed with multiple gauzes and compressed with an elastic band.

Results: The patient is discharged the next day. The dressing and Foley catheter are removed in 7 days. The patient continues to use the suprapubic catheter for 7 more days. The patient refrains from any sexual activity for 6 weeks and is closely followed.

Conclusions: Glans resurfacing is an emerging new appealing surgical technique that is already a recommendation in the EAU guidelines for the treatment of premalignant and superficial penile lesions. The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer.

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Figures

Figure 1
Figure 1
(a) Marking the circumcision line on the shaft of the penis. (b) Incising the marked skin, in order to perform the circumcision (sleeve technique). (c) Placing a tourniquet at the base of the penis. (d) The glans is marked in quadrants.
Figure 2
Figure 2
(a) Incising the epithelium and subepithelium of each quadrant of the glans. (b) Stripping the upper right quadrant of the glans, by removing the epithelium and subepithelium with tenotomy scissors (c) The upper right quadrant is completely peeled off. The upper left quadrant is semidetached and rolled backwards. The underlying spongiosum tissue is exposed. (d) The glans epithelium and subepithelium are completely removed.
Figure 3
Figure 3
(a) Estimating the graft size needed by accurately placing a white paper over the glans circumference. Blood is absorbed from the paper defining the borders. (b) Marking the size of the skin graft over the harvesting site of the thigh taking into account graft contraction once removed. (c) A dermatome is used for the harvesting of the partial thickness skin graft. (d) Perforating the skin graft, in order to improve graft survival.
Figure 4
Figure 4
(a) The graft is rolled over glans starting from the ventral side. Quilting sutures are placed accordingly. (b) A meatotomy is performed to compensate for possible stricture at the level of the meatus due to sutures approximating the skin graft to the urethra. (c) The proximal end of the graft is sutured to the distal shaft skin by everting the edges in order to recreate the corona of a normal penis. Multiple quilting sutures secure the graft to its bed. (d) A suprapubic and a urethra catheter are placed. The penis is dressed with multiple gauzes and compressed with an elastic band for graft immobilization.
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