Genital Reconstruction
Genital reconstruction covers operations that restore the form and function of the external genitalia after trauma, lichen sclerosus, oncologic resection, congenital anomaly, or gender-incongruence surgery. In practice, the key variables are defect extent (skin vs. corporal vs. urethral vs. composite), tissue-bed quality, erectile and sensory goals, and whether the procedure is primary, revision, or salvage. Peyronie's surgery is included here because the reconstructive question — straighten, lengthen, or prosthetically support the penis — is the same anatomic problem, not a medical sexual-dysfunction problem.
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.
17 of 17 techniques
| Technique | Domain | Notes |
|---|---|---|
| Buried Penis Repair | Adult-Acquired Buried Penis | Staged escutcheonectomy + panniculectomy with split-thickness skin grafting of the penile shaft and scrotoplasty. Best results when paired with weight loss and addresses the lichen sclerosus-obesity-stricture cycle driving the condition. |
| Tunica Albuginea Plication | Peyronie's Correction | Plication of the convex side of the penis to correct curvature without plaque excision. Best for curvature ≤60° with good erectile function and adequate penile length. |
| Plaque Incision / Excision with Grafting | Peyronie's Correction | Relaxing incision or full excision of the plaque with graft replacement (bovine pericardium, dermal allograft, buccal mucosa). Reserved for severe curvature, hourglass deformity, or indentation with preserved erectile function. |
| Penile Prosthesis with Straightening | Peyronie's Correction | IPP placement combined with manual modeling, relaxing incisions, or grafting when Peyronie's coexists with medically-refractory ED. Hammad multicenter adjunct data support combined approaches. |
| Phalloplasty | Gender-Affirming / Masculinizing | Free-flap or pedicled creation of a neophallus — radial forearm, anterolateral thigh, latissimus, or abdominal flap — with staged urethral lengthening and optional glansplasty, prosthesis, and scrotoplasty. |
| Metoidioplasty | Gender-Affirming / Masculinizing | Release of the hormonally enlarged clitoris with urethral lengthening using labia-minora flaps and vaginectomy. Preserves native erectile tissue and avoids free-flap morbidity. |
| Vaginoplasty | Gender-Affirming / Feminizing | Penile-inversion, peritoneal-pull-through, or intestinal vaginoplasty to create a neovagina with clitoroplasty and labiaplasty. Technique selection balances canal depth, lining type, and lubrication demands. |
| Vulvoplasty / Labiaplasty | Gender-Affirming / Feminizing | Feminizing external-genitalia-only operation without creation of a vaginal canal. Appropriate when canal creation is not desired or is contraindicated. |
| Genital Nullification | Gender-Affirming / Non-Binary | Removal of external genitalia without creation of a neovagina or neophallus, often with urethral shortening and perineal closure. Requested by some non-binary patients. |
| Revision / Salvage GAS | Gender-Affirming / Revision | Management of neourethral strictures, neovaginal stenosis, wound dehiscence, rectovaginal / rectoneovaginal fistula, and flap complications after primary gender-affirming surgery. |
| Penile Skin / Shaft Reconstruction | Post-Traumatic / Oncologic | STSG or FTSG resurfacing for post-Fournier's, post-LS, oncologic resection, or zipper/avulsion injuries. Scrotal and groin flaps used when graft bed is inadequate. |
| Cecil-Culp Procedure | Staged / Salvage Reconstruction | Two-stage penile-in-scrotum marsupialization — Cecil (1930s–40s) for severe proximal hypospadias, Culp (Mayo) modifications. Modern niche uses: recurrent UCF after failed hypospadias repair (Ehle 100% success), penile trauma with extensive skin loss, and salvage when BMG is not viable. |
| Penile Fillers (HA / PLA / Autologous Fat) | Penile Augmentation | Injectable subcutaneous girth enhancement — HA is the best-tolerated and best-studied (Yang RCT 16.95 mm gain to 48 wk; Boiko 1.7 cm midshaft). Resorbable, requiring repeat treatments. PLA stimulates collagen. Autologous fat carries 30–70% resorption. Illicit silicone / paraffin / mineral oil cause sclerosing lipogranuloma and require surgery in 78–91%. |
| Suspensory Ligament Release | Penile Augmentation | Division of the fundiform / suspensory ligaments to advance the intracorporeal penis anteriorly — most established surgical lengthening technique. Average 1.3 cm flaccid gain (range −1 to +3 cm); historically low satisfaction (35% overall; 27% in PDD). Trans-scrotal modifications (Karimian) and combined fat-flap dead-space management (Deskoulidi) emerging. |
| Penuma / Himplant Silicone Sleeve | Penile Augmentation | FDA-cleared (Penuma) silicone subcutaneous sleeve for cosmetic flaccid-penis enhancement; Himplant occupies the same procedural category. Elist 56.7% girth increase, 81% high satisfaction at 2–6 yr, 4.8% seroma, 3.3% infection. Removal rate up to 10% with risk of severe deformity. SMSNA: "may be considered" with explicit erosion / infection / removal counseling. |
| Glans Reconstruction / Glansplasty | Post-Traumatic / Oncologic | Reconstruction after partial glansectomy, distal penile SCC, or post-circumcision injury using split-thickness graft, buccal mucosa, or local advancement flaps. |
| Scrotal Reconstruction | Post-Traumatic / Oncologic | Post-Fournier's, post-burn, or post-resection scrotal coverage using medial thigh flaps, STSG, or staged rotational flaps. Testicular coverage drives technique selection. |