(697) A Novel Approach for Reconstruction of the Prepuce Following Circumcision

Introduction Treatment options and available data for foreskin reconstruction following circumcision remain sparse. Circumcision is the most common male surgery and is regularly performed in infancy for religious reasons or secondary to a disease process. Incentives to seek replacement include cosmetic and sexual dissatisfaction. These may attribute to a significant psychological burden for the patient. The following study reviews two multi-stage surgical preputial reconstructive approaches from a single surgeon. Objective To detail novel surgical approaches for reconstruction of the prepuce following circumcision. Methods All performed preputial reconstructions were studied in a tertiary Andrology centre. Case-notes and operation notes were retrospectively screened for patients age, date and reason for circumcision and details of the reconstructive approach recorded through perioperative photographs and diagrams. Post-operative complications included sepsis, prolonged hospital stay and poor cosmesis. The prepuce was reconstructed through 2 main approaches: 1. Utilising the penile shaft skin to reconstruct the prepuce and bridging the lower defect with a scrotal flap (figure 1) 2. the prepuce was reconstructed using the scrotal skin by burying the penis into the scrotum. (figure 2) Both approaches utilising the scrotal skin which is essential for reconstruction purposes. The utilisation of the skin flaps necessitates bilateral pedicles formation to ensure adequate blood supply to the flap. This was followed by stepwise division of the flap pedicles over several procedures. Patients were further assessed with a ‘patient reported outcome measure’ questionnaire and International Index of Erectile Function (IIEF) score. Results The study describes six total patients who received the initial reconstructive stage, with mean age 54 years. Four patients received scrotal grafts to reconstruct the prepuce and two had penile shaft pulled to recreate the prepuce. A median average of three further procedures were required to achieve full release of the pedicles over a 9–12-month period. Only one case was complicated with partial necrosis of the pedicled flap requiring debridement which recovered prior to the second procedure. All patients reported excellent satisfaction with function and cosmesis (figure 3 and 4) Conclusions Our evaluation demonstrates successful implementation of a novel surgical technique with low morbidity and excellent reported outcomes for reconstructing of the prepuce. Disclosure No