Penile Reconstructive Surgery

Penile reconstructive surgery has always been a notable challenge in the field of genitourinary reconstruction because of the fact that it attaches huge importance to the functional and aesthetic aspects of this organ and the genital region as a whole. During the last decades, many operative procedures and their modifications for the treatment of both congenital and acquired anomalies are published. Based on the established principles of reconstruction, as we strive forward in this difficult art, we also feel the need to adapt to growing demands of rewriting the stiff challenges of techniques, their modifications, the long-term results, and futuristic issues which encompass this subspeciality. One of the most common congenital anomalies is hypospadias. Repair of this anomaly has become easier with Snodgrass principle for distal and buccal mucosa graft combined with genital flaps for proximal forms. However, complication rate is still not minimized to be satisfied. Heidelberg group in the article entitled " Hypospadias " with their vast experience had discussed all aspects of hypospadias in details as it stands today commencing from its understanding as a developmental anomaly to its presentation, preparation, operative techniques as they stand today based on well defined historic and current concepts. Their overview emphasizes the fate of urethral plate in various distal and proximal surgical methods algorithmically to bring about satisfactory planning and execution of each treatment arm. The authors have in great details described their preferred approach of longitudinal preputial or penile flap in both distal and proximal hypospadias and presented its visual and schematic understanding. Reinberg et al. in " Tunneled tunica vaginalis flap for recurrent urethrocutaneous fistulae " in a retrospective clinical analysis present their 5-year data on a set of 12 boys who underwent tunneled tunical vaginalis flap repair for recurrent fistulae in all locations. Another group from Detroit have presented a unique group of patients in their 5-year study where they discuss a subset of " iatrogenic strictures " presenting in adulthood resulting from childhood hypospadias surgeries. The complexity of these cases is increased manifold due to reasons of delayed presentation of many decades, varying lengths, as well as poor healing capacity due to scarred territory from previous surgical attempts and associated complicating factors of renal failure and fistulae. The current management of patients with intersex, now named as disorders of sex development, presents results of updated etiological and outcome data as well as refined surgical procedures, as …