Total Glans Resurfacing TGR

Although the topical therapies described may be successful, they all have limitations and side effects. They require high levels of patient compliance and can be awkward to apply, often causing discomfort to the patients. Furthermore, the diffuse nature of EQ poses the risk of insufficient treatment and recurrence. Patients therefore need careful long-term surveillance and frequent re-treatment. The technique of TGR offers a surgical alternative. This procedure, first described by Bracka for the treatment of severe BXO28 and has been adapted for the management of CIS and stage Ta penile cancer patients with relapsing or extensive dis-ease.29 It involves removal of the glans epithelium and subepithelial tissues in quadrants. Frozen-section biopsies are then taken from the underlying corpus spongiosum in order to confirm complete excision. The corpus spongiosum of the glans is then covered with a split thickness skin graft. The detailed surgical technique is described in Chap. 5 . Watkin's group have reported the initial outcome data on ten patients undergoing TGR. The men were followed 3-monthly for 2 years, 6-monthly for a further 2 years, and yearly thereafter. They found no evidence of disease recurrence at a median follow-up of 30 months (range 7-45). The graft take was successful in all cases and excellent cosmetic results were described. All patients who were previously sexually active were again sexually active within 3-5 months of surgery.29

There are several advantages of using the technique of TGR. Unlike any other treatment, an undamaged histological specimen is obtained to confirm complete excision of the disease. This is important when dealing with a prema-lignant condition. Given that the glans and sub-coronal epithelial and subepithe-lial tissues are completely excised, the chance of local recurrence is minimal, although long-term follow-up is still required. Moreover, TGR restores normal anatomy with minimal scar tissue formation. It appears particularly suitable for younger men in whom there is minimal operative risk, and in whom cure is paramount.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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