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Genital Reconstruction

Genital reconstruction in the reconstructive-urology / urogynecology atlas covers operations that restore form and function of the external genitalia after trauma, lichen sclerosus, oncologic resection, FGM/C, congenital anomaly, or progressive obesity-driven (adult-acquired buried penis) disease — distinct from the gender-affirming pathway, which lives at 04k Gender-Affirming Surgery. The operative decision space splits into three anatomic cohorts that drive technique selection: penile (shaft skin, AABP, glans, cancer-related), scrotal (Fournier's, lymphedema, oncologic, post-orchiectomy), and vulvar (vulvar cancer, EMPD, VIN, FGM/C, lichen sclerosus, GSM-related fat-grafting).

Peyronie's correction lives at 04j Peyronie's Disease; gender-affirming genital surgery lives at 04k; penile augmentation (PDD / SPS) lives in the Small Penis Syndrome clinical-conditions article.

General Principles​

  • Principles of Genital ReconstructionSkin-bed vs. corporal vs. urethral defect assessment, STSG vs. FTSG vs. flap selection, the lichen sclerosus-obesity-stricture cycle, staging, erectile-preservation principles, and the place of primary perineal urethrostomy as a legitimate reconstructive endpoint.

Decision Frameworks by Anatomic Cohort​

  • Penile Reconstruction6-step Decision Framework + 23-row treatment database across 8 domains (AABP, shaft skin grafts / flaps, tissue substitutes, tissue expansion, free flaps, glans / cancer, staged / salvage). Anchored on Kristinsson 2021, Alwaal 2015 UCSF STSG, Mendel 2023 / McLaughlin 2024 bipedicled scrotal, Crane 2026 Matriderm, Schlaepfer 2023 PAS classification, Pang 2026 glansectomy SR, Baumgarten 2018, and Brouwer 2023 EAU-ASCO.
  • Scrotal Reconstruction7-step Decision Framework + 24-row database across 9 domains (primary closure, skin graft, pedicled flap, lymphatic flap, testicular thigh pouch, NPWT, prosthesis, aesthetic, salvage). Anchored on Schifano 2022 SR, Hayon 2021 orchidopexy + STSG, Alammar 2026 Fournier's flap SR, Sahai 2021 30-yr island groin, Abdelfattah 2023 SCIP-LFT, Wisenbaugh 2018 MLL, Atwater 2025 Rigicon Testi10, and Thomas 2021 aesthetic algorithm.
  • Vulvar Reconstruction8-step Decision Framework + 30-row database across 7 domains (primary closure / graft, local random / fasciocutaneous, regional pedicled, free tissue transfer, FGM/C reconstruction, regenerative / fat grafting, lichen sclerosus surgical). Intentionally focused on non-GAS vulvar reconstruction. Anchored on Höckel-Dornhöfer 2008, Toulouse Algorithm (Ricotta 2025), Kwong 2025 prospective, O'Dey 2024 FGM/C, Confalonieri 2017 V-Y vs LPF, and Eseme 2022 VRAM-vs-gracilis meta.

See Also​