V05-12: Penile skin flap neourethra after radical penile amputation
Squamous cell carcinoma of the urethra is rare. Traditional treatment for bulbar urethral cancer is decided by the local extent of the disease and varies from wide local excision to total amputation of the penis. The treatment involves total penectomy with cystoprostato urethrectomy and ileal conduit. The local recurrence after such a major surgery is high and five-year survival is less than 20%. Those patients who refused ileal conduit, we discussed all the alternatives. To preserve natural voiding, we describe a new technique of penile skin flap neourethra after radical penile amputation.
5 Patients are included in the series. All patients presented with lump in the perineum. In two patients, the lumps were incised thinking that they were periurethral abscesses by the referring surgeon. Two patients were referred after first stage of Johansson’s urethroplasty for non-healing of the wound. One patient was diagnosed on endoscopy. Histopathology was squamous cell carcinoma of the urethra. MRI scan was performed to check the local extent of the disease. Endoscopic biopsy of the membranous and prostatic urethra was normal. A circumcision incision is made. The penis is degloved. 3cm wide dorsal penile skin is preserved with its underlying dartos tissue. Both the corpora cavernosa with urethra are excised. After oncological clearance neo urethra is constructed. The proximal membranous urethra is identified. The flap of dorsal penile skin with dartos is tubularised over a catheter, rotated down to the perineum and then anastomosed to membranous urethra.
We have performed this new technique in 5 patients. All 5 patients voided well through the neourethral opening. The mortality of squamous cell carcinoma is high. With our new technique, patients have a quality voiding. Two patients died due to local recurrence within 6 months.1 patient required DVIU for anastomotic narrowing.
Our new technique of penile skin flap neourethra after radical penile amputation allows patients to void from the perineum and are continent. It gives an option for those who refuse ileal conduit and provides better quality of life.