Parachute technique for partial penectomy

Surgical Technique

Parachute Technique for Partial Penectomy

International Braz J Urol

Vol. 36 (2): 198-201, March - April, 2010 doi: 10.1590/S1677-55382010000200010

Parachute Technique for Partial Penectomy Fernando Korkes, Oseas C. Neves-Neto, Marcelo L. Wroclawski, Marcos Tobias-Machado, Antonio C. L. Pompeo, Eric R. Wroclawski Division of Urology, ABC Medical School, Sao Paulo, SP, Brazil

ABSTRACT Purpose: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly DSSOLHGDSSURDFKIRUEHVWRQFRORJLFDOUHVXOWV:HKHUHLQSURSRVHDVLPSOHPRGL¿FDWLRQRIWKHFODVVLFWHFKQLTXHRISDUWLDO penectomy, for better cosmetic and functional results. Technique: ,ISDUWLDOSHQHFWRP\LVLQGLFDWHGWKHSUHVHQWWHFKQLTXHFDQEULQJDGGLWLRQDOEHQH¿WV'LIIHUHQWIURPFODVVLFDO WHFKQLTXHWKHXUHWKUDLVVSDWXODWHGRQO\YHQWUDOO\$QLQYHUWHG³9´VNLQÀDSZLWKFPRIH[WHQVLRQLVVHFWLRQHGYHQWUDOO\ 7KHVXWXUHLVSHUIRUPHGZLWKYLFU\OLQD³SDUDFKXWH´IDVKLRQEHJLQQLQJIURPWKHYHQWUDOSRUWLRQRIWKHXUHWKUDDQG WKH³9´ÀDSIROORZHGE\WKH³9´ÀDSDQJOHVDQGWKDQE\WKHGRUVDOSRUWLRQRIWKHSHQLV$IWHUFRPSOHWLRQRIWKHVXWXUH D)ROH\FDWKHWHUDQGOLJKWGUHVVLQJDUHSODFHGIRUKRXUV Conclusions: 6HYHUDOFRPSOH[UHFRQVWUXFWLYHWHFKQLTXHVKDYHEHHQSUHYLRXVO\SURSRVHGEXWQRUPDOO\UHTXLUHVSHFL¿F VXUJLFDODELOLWLHVDGHTXDWHSDWLHQWVHOHFWLRQDQGVWDJHGSURFHGXUHV:HEHOLHYHWKDWWKHVHUHFRQVWUXFWLYHWHFKQLTXHVDUH YHU\XVHIXOLQVRPHVSHFL¿FVXEVHWVRISDWLHQWV+RZHYHUWKHWHFKQLTXHKHUHLQSURSRVHGLVDVLPSOHDOWHUQDWLYHWKDWFDQ EHDSSOLHGWRDOOPHQDIWHUDSDUWLDOSHQHFWRP\DQGWDNHVWKHVDPHDPRXQWRIWLPHDVWKDWLQWKHFODVVLFWHFKQLTXH,Q FRQFOXVLRQWKH³SDUDFKXWH´WHFKQLTXHIRUSHQLOHUHFRQVWUXFWLRQDIWHUSDUWLDODPSXWDWLRQQRWRQO\LPSURYHVWKHDSSHDUDQFH RIWKHSHQLVEXWDOVRPDLQWDLQVDQDGHTXDWHIXQFWLRQ Key words: penis; penile cancer; surgery; surgical procedures; reconstructive surgical procedures Int Braz J Urol. 2010; 36: 198-201

INTRODUCTION

SURGICAL TECHNIQUE

Penile carcinoma is a rare but mutilating ma lignancy. Tumors are often localized in the penis at the time of diagnosis, and they may be better controlled E\ VXUJLFDO H[FLVLRQ   ,Q WKLV FRQWH[W SDUWLDO penectomy is the most commonly applied approach IRUEHVWRQFRORJLFDOUHVXOWV :HKHUHLQSURSRVH D VLPSOH PRGL¿FDWLRQ RI WKH FODVVLF WHFKQLTXH RI partial penectomy, for better cosmetic and functional results.

 $IWHUGLDJQRVLVRISHQLOHFDUFLQRPDFRQ¿UPHG by incision biopsy, patients are elected for surgical treat PHQW:KHQSRVVLEOHPRUHFRQVHUYDWLYHSURFHGXUHV such as postectomy or glansectomy are performed. If SDUWLDOSHQHFWRP\LVLQGLFDWHGWKHSUHVHQWWHFKQLTXH FDQEULQJDGGLWLRQDOEHQH¿WV2XU,QVWLWXWLRQDO5HYLHZ %RDUGDSSURYHGWKHSUHVHQWVWXG\ Patients are generally operated in the supine SRVLWLRQXQGHUVSLQDODQHVWKHWLFEORFN$IWHUSURSHU

198

Parachute Technique for Partial Penectomy

RI%XFN¶VIDVFLD7RXUQLTXHWLVUHPRYHGDQGDGHTXDWH hemostasia is obtained.  'LIIHUHQWIURPFODVVLFDOWHFKQLTXHWKHXUHWKUD LVVSDWXODWHGRQO\YHQWUDOO\$QLQYHUWHG³9´VNLQÀDS ZLWKFPRIH[WHQVLRQLVVHFWLRQHGYHQWUDOO\7KH VXWXUHLVSHUIRUPHGZLWKYLFU\OLQD³SDUDFKXWH´ IDVKLRQ EHJLQQLQJ IURP WKH YHQWUDO SRUWLRQ RI WKH XUHWKUDDQGWKH³9´ÀDSIROORZHGE\WKH³9´ÀDS angles and then by the dorsal portion of the penis )LJXUHVDQG $IWHUFRPSOHWLRQRIWKHVXWXUHD )ROH\FDWKHWHUDQGOLJKWGUHVVLQJDUHSODFHGIRU hours.

DVHSVLVDVXUJLFDOJORYHRUFRQGRPVHFXUHGGLVWDOO\WR the proposed line of amputation excludes the lesion. $WRXUQLTXHWLVDSSOLHGDWWKHEDVHRIWKHSHQLV7KH VNLQ LV LQFLVHG FLUFXPIHUHQWLDOO\ DURXQG WKH SHQLV GHHSHQLQJ WR %XFN¶V IDVFLD7KH XUHWKUD LV LVRODWHG IURPWKHFRUSRUDFDYHUQRVDDQGGLYLGHGDLPLQJWR REWDLQDWOHDVWFPGLVWDOUHGXQGDQF\EXWZLWKRXW RQFRORJLFDO FRPSURPLVH DW OHDVW  FP PDUJLQ  'RUVDOYHLQFRPSOH[LVOLJDWHGFRUSRUDDUHGLYLGHG and the surgical specimen is sent to the laboratory for IUR]HQVHFWLRQDQDO\VLV&RUSRUDDUHVHFXUHGZLWKFRQ WLQXRXVVXWXUHVZLWKYLFU\ORSSRVLQJWKHPDUJLQV

Figure 1 – Schematic drawing of parachute technique for partial penectomy. A) Penile tumor elective for partial penectomy. B) A surgical glove is secured distally to the proposed line of amputation and a tourniquet is applied at the base of the penis. C) Skin is incised circumferentially around the penis, deepening to Buck’s fascia, the urethra is isolated from the corpora cavernosa, divided and spatulated only ventrally. D) Corpora cavernosa are closed with continuous sutures with Vicryl 2-0, the tourniquet is removed and adequate hemostasis is obtained. E) Final suture is performed with Vicryl 4.0 in a “parachute” fashion, beginning from the ventral portion of the XUHWKUDDQGWKH³9´ÀDSIROORZHGE\WKH³9´ÀDSDQJOHVDQGWKDQE\WKHGRUVDOSRUWLRQRIWKHSHQLV) )LQDODVSHFW

199

Parachute Technique for Partial Penectomy

LQJXLQDOO\PSKDGHQHFWRP\DOVRZLWKRXWHYLGHQFHRI GLVHDVH1RFDVHVRIPHDWDOVWHQRVLVZHUHREVHUYHG DQGSDWLHQWVZHUHVDWLV¿HGZLWKWKH¿QDOUHVXOWUHVHP EOLQJWKHDVSHFWRIDSDWLHQWZLWKSKLPRVLV$OWKRXJK WKHSUHVHQWWHFKQLTXHKDVEHHQDSSOLHGRQO\WRDIHZ SDWLHQWVZHDUHEHJJLQJDSURVSHFWLYHVWXG\WRHYDOX DWHORQJWHUPRXWFRPHV  ,QFRQFOXVLRQWKH³SDUDFKXWH´WHFKQLTXHIRU penile reconstruction after partial amputation not RQO\LPSURYHVWKHDSSHDUDQFHRIWKHSHQLVEXWDOVR PDLQWDLQVDQDGHTXDWHIXQFWLRQ

CONFLICT OF INTEREST None declared.

Figure 2 – Final aspect of parachute technique for partial penectomy.

REFERENCES

COMMENTS

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Accepted after revision: October 15, 2009 Correspondence address: 'U)HUQDQGR.RUNHV 5XD3LUDSRUD 6mR3DXOR63%UD]LO (PDLOINRUNHV#WHUUDFRPEU

EDITORIAL COMMENT In this manuscript, the authors describe a QRYHODSSURDFKWRWKHVXUJLFDOPDQDJHPHQWRISHQLOH cancer. In this surgical technical report, the cosmetic and functional outcomes of partial penectomy us LQJDYHQWUDOVSDWXODWLRQRIWKHXUHWKUDDQG³9´ÀDS WHFKQLTXHKDYHEHHQUHSRUWHG,DSSODXGWKHDXWKRUV IRUWKHLULQQRYDWLYHVXUJLFDODSSURDFKZKLFKDSSHDUV highly reproducible and technically feasible in most FDVHVRISHQLOHFDUFLQRPD$OWKRXJKWKHDXWKRUVKDYH GLVFXVVHGEULHÀ\WKHIRXUFDVHVLQZKLFKWKH³SDUD FKXWH´WHFKQLTXHRISDUWLDOSHQHFWRP\ZDVXWLOL]HG WKHDXWKRUVZLOOQHHGWRYDOLGDWHWKHLURXWFRPHVLQD SURVSHFWLYHWULDOLQDODUJHUFRKRUWRISDWLHQWVSULRU WREHLQJFRQVLGHUHGD³VXSHULRU´VXUJLFDODSSURDFK Similarly, the authors should obtain an index of HUHFWLOHIXQFWLRQHJ,,() EHIRUHDQGIROORZLQJ SDUWLDOSHQHFWRP\XVLQJWKHVWDQGDUGDQG³SDUDFKXWH´ WHFKQLTXHZKHUHE\XOWLPDWHO\YDOLGDWLQJWKHVXSHULRU IXQFWLRQDORXWFRPHVRIWKLVUHSRUWHGWHFKQLTXH  5HFHQWDGYDQFHVLQWKHSULPDU\PDQDJHPHQW RISHQLOHFDQFHUKDYHKLJKOLJKWHGWKDWSHQLOHSUHVHUY ing approaches can be employed in select patients ZKHUHE\RIIHULQJWKHSRWHQWLDORILPSURYHGTXDOLW\RI

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