The Individualized Surgical Approach of Penoscrotal Transposition according to the Anatomical Position of the Penis

Changhee Yoo; Kyunghyun Moon; Kun Suk Kim

doi:10.4111/kju.2006.47.3.287

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Yoo, Moon, and Kim: The Individualized Surgical Approach of Penoscrotal Transposition according to the Anatomical Position of the Penis

Original Article

Korean Journal of Urology

Korean Journal of Urology 2006; 47(3): 287-292.

Published online: 31 March 2006

DOI: https://doi.org/10.4111/kju.2006.47.3.287

The Individualized Surgical Approach of Penoscrotal Transposition according to the Anatomical Position of the Penis

Changhee Yoo, Kyunghyun Moon¹, Kun Suk Kim

Department of Urology, Asan Medical Center, Seoul, Korea.

¹Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Corresponding author (kskim2@amc.seoul.kr)

Received 27 June 2005 Accepted 29 September 2005

Abstract

Purpose

Some patients still complain of a downward urine stream and a poor cosmetic result after the standard surgery, scrotoplasty because many patients with hypospadias basically have a low-set penis. We applied and evaluated a new concept for the surgery to improve the surgical results.

Materials and Methods

22 patients underwent surgery for PST from January 1997 to June 2004. We performed transposition of penis in 7 patients, scrotoplasty in 13 and partial wedge resection of the scrotum in 2 who had the mild form of PST. Transposition of the penis is a surgical technique in which the skin of the penoscrotal junction is incised circumferentially and phallus is delivered into the buttonhole that is created in the normal anatomical position for the penis. We evaluated the cosmetic results using a satisfaction scoring system (1 to 5 scores) that was completed by the parents and the functional results by checking the angle of the urine stream in the standing position.

Results

There was no major complication for the 7 patients who underwent transposition of the penis. The mean satisfaction score was 4.6±0.8 and the angle of the urine stream was above 45° in all patients. In the case of scrotoplasty, the mean satisfaction score was 3.6±0.9: half of them showed an angle of urine stream under 45° and they complained of trouble when voiding.

Conclusions

As the anatomical location of the penis, scrotoplasty is good for the normally positioned penis with PST, transposition of the penis for the low-set penis, and partial resection of the scrotal skin for the mild form. This individualized approach could improve the cosmetic and functional results for patients with PST.

Keywords: Urogenital abnormalities, Scrotum

Figures and Tables

Fig. 1

Scrotoplasty, surgical design before (A) and after the procedure (B).

Fig. 2

Transposition of penis: surgical design before the procedure (A), excision of the skin in the button hole site (B), transposing the penis to the button hole site (C), and after the procedure (D).

Fig. 3

Partial wedge resection of the scrotum: preoperative design in the patient with the mild form of penoscrotal transposition (A) and after the procedure (B).

Fig. 4

Four cases of penoscrotal transposition who are operated on using the procedure of transposition of the penis: (A) before the procedure, (B) design of the procedure, and (C) after the procedure.

Fig. 5

Lateral view of the penis of a non-hypospadiac child (A) and a hypospadiac patient in the supine position (B). On the oblique view of the hypospadiac patient, the root of penis is in a low set position compared with that of the non-hypospadiac child.

Table 1

Patient's characteristics

Table 2

Comparison of the cosmetic and functional results between scrotoplasty and transposition of the penis

^*: satisfaction scores: 1-very unsatisfactory, 2-unsatisfactory, 3-intermediate degree of satisfaction, 4-satisfactory, 5-very satisfactory, ^†: angle between body axis and maximal urine stream

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