Penile Reconstruction presents a variety of complex issues. Often this requires not only surgical procedures but also psychological rehabilitation.

The loss of or trauma to the penis can often negatively affect many aspects of your life, everything from your own emotional well-being to your relationship with your spouse or partner.

There are various clinical conditions which may require male patients to need penile reconstruction. Among these conditions, the most common are partial and complete amputation of the penis caused by trauma or when penile tissue has been removed to treat cancer of the penis. Penile reconstruction might be necessary for patients when the size of the penis is inadequate to engage in penetrative sexual intercourse.

When sexual and urinary functions are compromised in patients with a buried penis or lichen sclerosus of the penis, penile reconstruction can yield excellent cosmetic and functional results. The goal of penile reconstruction is to create and/or restore a functioning and aesthetically pleasing phallus, including the ability to achieve sexual function. An important factor is that the reconstructed phallus resembles a normal penis in all aspects. Depending on the severity of the trauma or penile defects will decide the amount and extent of surgery that will be involved in the reconstruction.

Our Uro-Andrology department is led by Mr. Giulio Garaffa, an award-winning Consultant Uro-Andrologist with over 20 years’ international medical experience in this field. Mr Garaffa has a global reputation for his excellence in urology and andrology and is one of the leading experts in the fields of erectile dysfunction, congenital penile curvature, complex penile reconstruction, phalloplasty, Peyronie’s disease, male infertility and microsurgery. 

 

Frequently Asked Questions

A penile prosthesis is an artificial stiffener, which is inserted under general anaesthetic into the chambers of the penis to guarantee the rigidity necessary for sexual intercourse. A penile prosthesis reproduces a normal erection and preserves all the normal feeling and sensation during intercourse. The quality of the erection obtained with a penile prosthesis is excellent and most patients and partners are very happy with the outcome post surgery.

The procedure usually takes just under an hour and the patient is discharged the same day. The prosthesis is usually inserted through a 3cm long incision via the scrotal sac. Sexual activity can be resumed 6 weeks post-surgery.

There are 2 kinds of penile prostheses: semirigid and inflatable. The semirigid or malleable prosthesis is made of two semirigid cylinders, which are inserted into the chambers of the penis. They produce a constant erection and the penis is usually bent laterally to be concealed in the underwear. The inflatable prosthesis is made of two cylinders, which sit in the chambers of the penis along with a scrotal pump and an intra-abdominal reservoir - a system filled with sterile water, and requires the patient to press a pump to transfer the fluid from the reservoir to the cylinders. This produces good level of rigidity and a natural looking erection. When the sexual intercourse is completed, the patient presses the deactivation button of the pump to transfer the fluid back into the reservoir and to render the penis flaccid.

Inflatable penile prosthesis by far produces the best results in terms of rigidity and concealing of the penis in flaccidity. Malleable penile prosthesis are only used in selected groups of patients.

There are various clinical conditions in genetic male patients where penile reconstruction may be required. Among these conditions, the most common are penile tissue loss due to trauma, surgery or excision of benign or malignant conditions of the penis.

When sexual and urinary functions are compromised in patients with buried penis or lichen sclerosus of the penis, penile reconstruction can yield excellent cosmetic and functional results and allow them to resume sexual and urinary function with confidence.

Buried penis indicates the clinical situation when the penis is hidden in the prepubic fat. A buried penis is usually present in patients with excessive fat in the pubic area (=lower abdomen) or when excessive skin has been removed during circumcision or when the two situations coexist. 

In patients with buried penis sexual and urinary function are severely compromised.

Quality of life tends to be poor as the patient is not able to expose the penis while urinating and therefore the pooling of urine in the abdominal skinfolds causes maceration of the skin and recurrent urinary infections, which can ultimately lead to renal damage. As the skin is macerated by the urine and is always moist, the formation of lichen sclerosus is quite common and this makes the situation worse.

Buried penis frequently requires the combined intervention of a bariatric surgeon and of the uro-andrologist. 

Significantly overweight patients need to lose weight first and in this case the intervention of the bariatric surgeon can be extremely useful.

Once patients have reached the target weight, the management of the buried penis requires the excision of the suprapubic fat and of all the excess skin performing an abdominoplasty. 

If there is not enough penile skin, or if the skin needs to be removed because it is affected by lichen sclerosus, the penis needs to be reconstructed using a variety of skin grafts. In expert hands, abdominoplasty, excision of the suprapubic fat and penile reconstruction, yield excellent functional and cosmetic results and allow patients to restore sexual and urinary function.

A skin graft is a patch of skin that is surgically removed from one area of the body (=donor site) and transplanted to another area (=the recipient area). The characteristics of the skin graft depend on the area from which the graft has been removed and on its thickness. The choice of the donor area and of the thickness of grafts should be therefore tailored to the characteristics of the recipient area and to patient’s expectations. 

A skin graft might be necessary to reconstruct the skin of the glans and/or of the penile shaft. Usually, grafts yield excellent results in patients who have lost part of penile skin because of trauma or of excessive circumcision. Skin grafts can be extremely useful also following surgical excision of lichen sclerosus of the penis or of penile cancer. In most cases, following grafting, patients can resume a normal sexual and urinary function.

What to expect

Free Consultation with one of our Patient Advisors

We offer a free, no-obligation 30-60 minute consultation with one of our Patient Advisors. They will work with you to understand your objectives and the results you want to achieve, talk you through the procedure and answer any questions you may have. If you decide that you would like to proceed to the next step and see a surgeon, your Patient Advisor will be happy to arrange this for you. At this point, you will be required to pay a consultation fee. 

Surgical Consultation

The next step is for you to meet your chosen surgeon at the Cadogan Clinic. Your surgeon will use this time to make a comprehensive medical assessment of you, your condition, and your expectations before making a recommendation and personalised treatment plan for you. You will then discuss the outcomes you can expect to see and ask any questions.

The Procedure

On the day of your procedure you will be welcomed at the Cadogan Clinic by your Patient Advisor and dedicated nursing staff. Following a brief medical check, you will meet with both your surgeon and anaesthetist to run through the details of your procedure one final time and answer any last questions you may have.  

Recovery

After the procedure, you will recover in the capable hands of our aftercare team. As we are a day-case facility you can expect your recovery to be complete within 2 to 3 hours. If your surgeon is happy with your results, you will be able to be discharged from the Clinic the very same day. In some cases patients may wish to stay locally in our exclusive partner hotel the day before or after your procedure in order to be close to their surgeon. Talk to us about these options if this is for you. 

After Care & Support

Our care and support continues in the days and weeks following your procedure with our complimentary aftercare programme. This comprised of a series of appointments made with your surgeon and nursing team to monitor your progress and recovery. They will also introduce you to several scar minimization techniques and bespoke products to aid your progress. Our team are also on call to answer any questions you have around your surgery at any time you are concerned.

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