Penile Preserving and Reconstructive Surgery: The Initial Experience with Scrotal Flap in the Management of Penile Cancer

Purpose: Organ-Sparing Surgery (OSS) in Penile Cancer (PC) maintains sexual and voiding function, as well as quality of life and psychological well-being. Herein, we describe a reconstructive surgery using a scrotal flap after partial penectomy when there is not enough skin to cover the penile shaft. Methods: A PubMed search was conducted using the keywords organ sparing/conserving in penile cancer, alone or in combination with partial penectomy; partial penectomy; reconstructive surgery techniques; and surgical flaps to identify OSS techniques. We reconstructed the neoglans with a urethral flap and the penile skin shaft with a scrotal flap at the same time as the surgical resection in 5 patients who underwent partial penectomy for penile Squamous Cell Carcinoma (SCC). Results: We noted no neomeatal stenosis or flap necrosis secondary to the technique. Surgical wound infection was observed in 1 patient (20%) and was treated with intravenous antibiotic therapy. Surgical wound hematoma was observed in 1 patient (20%) with no need for drainage. At this time, there is no tumor recurrence, and voiding function is preserved. Regarding sexual function, the patients maintain penetration with Phosphodiesterase Type 5 Inhibitors (PDE5) or intracavernous injection. Conclusion: OSS with a scrotal flap proved to be a safe and viable option for the treatment of localized PC, ensuring a favorable penile appearance, preserving sexual and voiding function, and providing good quality of life and psychological well-being without compromising oncological outcomes.