Weibl Peter, Plank Christina, Hoelzel Rudolf, Hacker Stefan, Remzi Mesut, Huebner Wilhelm
Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Austria.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
Arab J Urol. 2018 Mar 21;16(2):218-223. doi: 10.1016/j.aju.2018.02.002. eCollection 2018 Jun.
Partial penectomy (glansectomy with/or without distal corporectomy) is an acceptable alternative for smaller distal pT3 penile carcinoma lesions in highly motivated and compliant patients. The authors describe a novel technique of neo-glans reconstruction using a tunica vaginalis (TV) testis allograft. However, due to an unclear resection margin on final histology, the patient underwent re-do surgery with a neo-glans revision using the well-established mesh split-thickness skin graft (STSG) technique. The penile length was preserved and the penile and bulbar part of the urethra was additionally mobilised in order to obtain a natural and aesthetic result for the meatus. Neo-glans reconstruction with TV coverage may be another promising alternative, which certainly requires further evaluation. We believe that the donor-site associated morbidity is minimal when compared to other harvesting sites. However, this is just an assumption, because direct comparison data on grafting techniques and neo-glans reconstruction are not available. Nevertheless, we think that for re-do procedures a standardised approach using a STSG technique should be the treatment method of choice.
部分阴茎切除术（龟头切除术伴或不伴远端阴茎体切除术）对于积极性高且依从性好的患者中较小的远端pT3阴茎癌病变而言是一种可接受的替代方案。作者描述了一种使用睾丸鞘膜（TV）同种异体睾丸进行新龟头重建的新技术。然而，由于最终组织学检查切缘不明确，该患者接受了再次手术，采用成熟的网状中厚皮片（STSG）技术对新龟头进行修复。阴茎长度得以保留，并且额外游离了阴茎和尿道球部，以便使尿道口获得自然美观的效果。用TV覆盖进行新龟头重建可能是另一种有前景的替代方案，当然这肯定需要进一步评估。我们认为，与其他取材部位相比，供区相关的发病率极低。然而，这只是一种假设，因为目前尚无关于移植技术和新龟头重建的直接对比数据。尽管如此，我们认为对于再次手术，采用STSG技术的标准化方法应是首选的治疗方式。
