Distal Corporectomy and Split Thickness Skin Grafting

This more extensive technique is required if there is evidence of corporal involvement, or if frozen sections of the corpora, urethra, or tunica albuginea are positive.

The operation is similar to a total glansectomy described above but includes the resection of the distal corporal heads and adjacent urethra. A rounded neoglans is then reconstructed from the corpora. The shaft skin is fully mobilized to prevent later retraction and shortening, and the denuded corporal heads are then covered by a split thickness skin graft. Penile lengthening manoeuvres can be performed at the same time or at a later date.51 An extra 2-3 cm can be gained by dividing the penile suspensory ligaments beneath the pubic arch. A dorsal V-Y skin advancement and a ventral V-Y phalloplasty to lower the insertion of the scrotal skin may also help relieve tethering and traction.53

The cosmetic outcome is better than for conventional surgery. However, following excision of larger tumors not all patients will have an adequate penile length to allow voiding while standing or be able to have penetrative sexual intercourse. Therefore, patients need to be well informed prior to surgery and expectations managed accordingly. Case selection is very important, as is close follow-up. The technique can also be used to salvage recurrent disease.54

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