Scrotal reconstruction and testicular prosthetics

Abstract

Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.

Traumatic Degloving Injury of Penile and Scrotal Skin: A Case Report and Review of Literature

“…It has been shown that the most common complication after scrotal skin grafting is wound breakdown, which commonly occurs around the graft edges [31], but in the present case the graft take was close to 100% and there were no signs of infection or hematoma. There was one early disadvantage of this procedure which was painful erections in the early postoperative period but these painful episodes rarely continue.…”

3D Printing Improved Testicular Prostheses: Using Lattice Infill Structure to Modify Mechanical Properties

“…The results shown in Figure 5 show how the hardness of the 3D printed testicles correlates to its relative density while revealing the hardness of the market prostheses exceeded the hardness of samples with relative densities 0.3 and 0.4 which is the range we would expect the hardness of a human testicle to be (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The top side of each market prosthesis was much harder than the left, right, and bottom positions because the suture holes located there were made from a harder material.…”

“…These aspects can adversely affect physical exercise, sexual activity and confidence, leading to dissatisfaction and regretting the decision for accepting an implant. Sizes for testicular prostheses offered on the market are limited to small, medium, and large despite the individual nature of the human body (4)(5)(6)(7). Additionally, they are designed to be sutured in place only in one position at the top of the prosthesis allowing them to freely rotate around that point inside the scrotum (8).…”

A Modified Scrotoplasty for Treating Severe Penoscrotal Webbing in Children

“…However, recent studies have found that many PSW children and their parents suffer from psychological or social pressure because of the unsatisfactory appearance of the penis during their growth. Some severe cases have adult problems such as sexual intercourse disorder, difficulty in using a condom and/or profound effects on sexual self-esteem ( 15 – 18 ). In the clinic, it is necessary to treat this kind of simple webbed penis with phimosis, since a comparative study conducted by Herndon et al ( 19 ) confirmed that the quality of life of children with webbed penis treated surgically in childhood was significantly improved compared with those treated in their youth ( 19 ).…”

“…The angle of penis and scrotum in the horizontal position 68 in using a condom and/or profound effects on sexual selfesteem (15)(16)(17)(18). In the clinic, it is necessary to treat this kind of simple webbed penis with phimosis, since a comparative study conducted by Herndon et al (19) confirmed that the quality of life of children with webbed penis treated surgically in childhood was significantly improved compared with those treated in their youth (19).…”