Reconstructive surgery in penile trauma and cancer

Penile reconstructive surgery requires expertise in genital surgery, whether it is for traumatic injuries or penile cancer. The stages of initial assessment and management of traumatic penile injuries and penile cancer, and the different reconstructive techniques available, are described in this review by David Ralph and colleagues. This article provides an overview of the current concepts in reconstructive surgery following penile trauma, penile fracture and penile cancer. It covers the initial management of penile trauma, with the aim of preservation of as much viable tissue as is practical, and also provides advice on dealing with penile avulsion and amputation injuries. The best treatment for penile fracture—immediate surgical exploration and repair—is outlined and discussed. Finally, penile cancer management is reviewed, from initial biopsy to definitive treatment of the penile lesion—including wide excision, partial glansectomy, total glansectomy, and partial and total penectomy. It is concluded that appropriate surgery in all these conditions reduces subsequent long-term problems in sexual function, cosmesis, psychology, and (in cancer cases) longevity. The same reconstructive techniques can be applied for different penile conditions, and it is suggested that surgeons become experienced in genital surgery as a whole, rather than in oncology or trauma alone.