198
Parachute Technique for Partial Penectomy
International Braz J Urol Vol. 36 (2): 198-201, March - April, 2010
Parachute Technique for Partial Penectomy
Fernando Korkes, Oseas C. Neves-Neto, Marcelo L. Wroclawski, Marcos Tobias-Machado, Antonio C. L. Pompeo, Eric R. Wroclawski
Division of Urology, ABC Medical School, Sao Paulo, SP, Brazil
ABSTRACT
Purpose:Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly DSSOLHGDSSURDFKIRUEHVWRQFRORJLFDOUHVXOWV:HKHUHLQSURSRVHDVLPSOHPRGL¿FDWLRQRIWKHFODVVLFWHFKQLTXHRISDUWLDO penectomy, for better cosmetic and functional results.
Technique: ,ISDUWLDOSHQHFWRP\LVLQGLFDWHGWKHSUHVHQWWHFKQLTXHFDQEULQJDGGLWLRQDOEHQH¿WV'LIIHUHQWIURPFODVVLFDO WHFKQLTXHWKHXUHWKUDLVVSDWXODWHGRQO\YHQWUDOO\$QLQYHUWHG³9´VNLQÀDSZLWKFPRIH[WHQVLRQLVVHFWLRQHGYHQWUDOO\ 7KHVXWXUHLVSHUIRUPHGZLWKYLFU\OLQD³SDUDFKXWH´IDVKLRQEHJLQQLQJIURPWKHYHQWUDOSRUWLRQRIWKHXUHWKUDDQG WKH³9´ÀDSIROORZHGE\WKH³9´ÀDSDQJOHVDQGWKDQE\WKHGRUVDOSRUWLRQRIWKHSHQLV$IWHUFRPSOHWLRQRIWKHVXWXUH D)ROH\FDWKHWHUDQGOLJKWGUHVVLQJDUHSODFHGIRUKRXUV
Conclusions:6HYHUDOFRPSOH[UHFRQVWUXFWLYHWHFKQLTXHVKDYHEHHQSUHYLRXVO\SURSRVHGEXWQRUPDOO\UHTXLUHVSHFL¿F VXUJLFDODELOLWLHVDGHTXDWHSDWLHQWVHOHFWLRQDQGVWDJHGSURFHGXUHV:HEHOLHYHWKDWWKHVHUHFRQVWUXFWLYHWHFKQLTXHVDUH YHU\XVHIXOLQVRPHVSHFL¿FVXEVHWVRISDWLHQWV+RZHYHUWKHWHFKQLTXHKHUHLQSURSRVHGLVDVLPSOHDOWHUQDWLYHWKDWFDQ EHDSSOLHGWRDOOPHQDIWHUDSDUWLDOSHQHFWRP\DQGWDNHVWKHVDPHDPRXQWRIWLPHDVWKDWLQWKHFODVVLFWHFKQLTXH,Q FRQFOXVLRQWKH³SDUDFKXWH´WHFKQLTXHIRUSHQLOHUHFRQVWUXFWLRQDIWHUSDUWLDODPSXWDWLRQQRWRQO\LPSURYHVWKHDSSHDUDQFH RIWKHSHQLVEXWDOVRPDLQWDLQVDQDGHTXDWHIXQFWLRQ
Key words: penis; penile cancer; surgery; surgical procedures; reconstructive surgical procedures
Int Braz J Urol. 2010; 36: 198-201
INTRODUCTION
Penile carcinoma is a rare but mutilating ma lignancy. Tumors are often localized in the penis at the time of diagnosis, and they may be better controlled E\ VXUJLFDO H[FLVLRQ ,Q WKLV FRQWH[W SDUWLDO penectomy is the most commonly applied approach IRUEHVWRQFRORJLFDOUHVXOWV:HKHUHLQSURSRVH D VLPSOH PRGL¿FDWLRQ RI WKH FODVVLF WHFKQLTXH RI partial penectomy, for better cosmetic and functional results.
Surgical TechniqueSurgical Technique
doi: 10.1590/S1677-55382010000200010
SURGICAL TECHNIQUE
$IWHUGLDJQRVLVRISHQLOHFDUFLQRPDFRQ¿UPHG by incision biopsy, patients are elected for surgical treat PHQW:KHQSRVVLEOHPRUHFRQVHUYDWLYHSURFHGXUHV such as postectomy or glansectomy are performed. If SDUWLDOSHQHFWRP\LVLQGLFDWHGWKHSUHVHQWWHFKQLTXH FDQEULQJDGGLWLRQDOEHQH¿WV2XU,QVWLWXWLRQDO5HYLHZ %RDUGDSSURYHGWKHSUHVHQWVWXG\
199
Parachute Technique for Partial Penectomy
DVHSVLVDVXUJLFDOJORYHRUFRQGRPVHFXUHGGLVWDOO\WR the proposed line of amputation excludes the lesion. $WRXUQLTXHWLVDSSOLHGDWWKHEDVHRIWKHSHQLV7KH VNLQLVLQFLVHGFLUFXPIHUHQWLDOO\DURXQGWKHSHQLV GHHSHQLQJWR%XFN¶VIDVFLD7KHXUHWKUDLVLVRODWHG IURPWKHFRUSRUDFDYHUQRVDDQGGLYLGHGDLPLQJWR REWDLQDWOHDVWFPGLVWDOUHGXQGDQF\EXWZLWKRXW RQFRORJLFDOFRPSURPLVHDWOHDVWFPPDUJLQ 'RUVDOYHLQFRPSOH[LVOLJDWHGFRUSRUDDUHGLYLGHG and the surgical specimen is sent to the laboratory for IUR]HQVHFWLRQDQDO\VLV&RUSRUDDUHVHFXUHGZLWKFRQ WLQXRXVVXWXUHVZLWKYLFU\ORSSRVLQJWKHPDUJLQV
RI%XFN¶VIDVFLD7RXUQLTXHWLVUHPRYHGDQGDGHTXDWH hemostasia is obtained.
'LIIHUHQWIURPFODVVLFDOWHFKQLTXHWKHXUHWKUD LVVSDWXODWHGRQO\YHQWUDOO\$QLQYHUWHG³9´VNLQÀDS ZLWKFPRIH[WHQVLRQLVVHFWLRQHGYHQWUDOO\7KH VXWXUHLVSHUIRUPHGZLWKYLFU\OLQD³SDUDFKXWH´ IDVKLRQEHJLQQLQJIURPWKHYHQWUDOSRUWLRQRIWKH XUHWKUDDQGWKH³9´ÀDSIROORZHGE\WKH³9´ÀDS angles and then by the dorsal portion of the penis )LJXUHVDQG$IWHUFRPSOHWLRQRIWKHVXWXUHD )ROH\FDWKHWHUDQGOLJKWGUHVVLQJDUHSODFHGIRU hours.
Figure 1 – Schematic drawing of parachute technique for partial penectomy. A) Penile tumor elective for partial penectomy. B) A surgi-cal glove is secured distally to the proposed line of amputation and a tourniquet is applied at the base of the penis. C) Skin is incised circumferentially around the penis, deepening to Buck’s fascia, the urethra is isolated from the corpora cavernosa, divided and spatu-lated only ventrally. D) Corpora cavernosa are closed with continuous sutures with Vicryl 2-0, the tourniquet is removed and adequate hemostasis is obtained. E) Final suture is performed with Vicryl 4.0 in a “parachute” fashion, beginning from the ventral portion of the
200
Parachute Technique for Partial Penectomy
COMMENTS
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7KHSXUSRVHRIWKHSUHVHQWWHFKQLTXHLVWR SUHVHUYHWKHPRUSKRORJLFDVSHFWRIWKHSHQLVFORVHU to a normal situation and additionally a permeable PHDWXV6HYHUDOFRPSOH[UHFRQVWUXFWLYHWHFKQLTXHV KDYHEHHQSUHYLRXVO\SURSRVHGEXWQRUPDOO\UHTXLUH VSHFL¿FVXUJLFDODELOLWLHVDGHTXDWHSDWLHQWVHOHFWLRQ DQGVWDJHGSURFHGXUHV:HEHOLHYHWKDWWKHVHUHFRQ VWUXFWLYHWHFKQLTXHVDUHYHU\XVHIXOLQVRPHVSHFL¿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igure 2 – Final aspect of parachute technique for partial penectomy.
LQJXLQDOO\PSKDGHQHFWRP\DOVRZLWKRXWHYLGHQFHRI GLVHDVH1RFDVHVRIPHDWDOVWHQRVLVZHUHREVHUYHG DQGSDWLHQWVZHUHVDWLV¿HGZLWKWKH¿QDOUHVXOWUHVHP EOLQJWKHDVSHFWRIDSDWLHQWZLWKSKLPRVLV$OWKRXJK WKHSUHVHQWWHFKQLTXHKDVEHHQDSSOLHGRQO\WRDIHZ SDWLHQWVZHDUHEHJJLQJDSURVSHFWLYHVWXG\WRHYDOX DWHORQJWHUPRXWFRPHV
,QFRQFOXVLRQWKH³SDUDFKXWH´WHFKQLTXHIRU penile reconstruction after partial amputation not RQO\LPSURYHVWKHDSSHDUDQFHRIWKHSHQLVEXWDOVR PDLQWDLQVDQDGHTXDWHIXQFWLRQ
CONFLICT OF INTEREST
None declared.
REFERENCES
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201
Parachute Technique for Partial Penectomy
EDITORIAL COMMENT
In this manuscript, the authors describe a QRYHODSSURDFKWRWKHVXUJLFDOPDQDJHPHQWRISHQLOH cancer. In this surgical technical report, the cosmetic and functional outcomes of partial penectomy us LQJDYHQWUDOVSDWXODWLRQRIWKHXUHWKUDDQG³9´ÀDS WHFKQLTXHKDYHEHHQUHSRUWHG,DSSODXGWKHDXWKRUV IRUWKHLULQQRYDWLYHVXUJLFDODSSURDFKZKLFKDSSHDUV highly reproducible and technically feasible in most FDVHVRISHQLOHFDUFLQRPD$OWKRXJKWKHDXWKRUVKDYH GLVFXVVHGEULHÀ\WKHIRXUFDVHVLQZKLFKWKH³SDUD FKXWH´WHFKQLTXHRISDUWLDOSHQHFWRP\ZDVXWLOL]HG WKHDXWKRUVZLOOQHHGWRYDOLGDWHWKHLURXWFRPHVLQD SURVSHFWLYHWULDOLQDODUJHUFRKRUWRISDWLHQWVSULRU WREHLQJFRQVLGHUHGD³VXSHULRU´VXUJLFDODSSURDFK Similarly, the authors should obtain an index of HUHFWLOHIXQFWLRQHJ,,()EHIRUHDQGIROORZLQJ SDUWLDOSHQHFWRP\XVLQJWKHVWDQGDUGDQG³SDUDFKXWH´ WHFKQLTXHZKHUHE\XOWLPDWHO\YDOLGDWLQJWKHVXSHULRU IXQFWLRQDORXWFRPHVRIWKLVUHSRUWHGWHFKQLTXH 5HFHQWDGYDQFHVLQWKHSULPDU\PDQDJHPHQW RISHQLOHFDQFHUKDYHKLJKOLJKWHGWKDWSHQLOHSUHVHUY ing approaches can be employed in select patients ZKHUHE\RIIHULQJWKHSRWHQWLDORILPSURYHGTXDOLW\RI
OLIHDQGHUHFWLOHIXQFWLRQSUHVHUYDWLRQ6HYHUDOFOLQLFDO SDUDPHWHUVPXVWEHFRQVLGHUHGZKHQFRQWHPSODWLQJ VXFK SHQLOH SUHVHUYLQJ DSSURDFKHV LQFOXGLQJ WKH primary tumor stage, grade, location of the penile OHVLRQDQGDELOLW\WRPDLQWDLQD³IXQFWLRQDO´SHQLV ZKHUHE\PDLQWDLQLQJWKHDELOLW\WRGLUHFWDXULQDU\ VWUHDPDQGSRWHQWLDOO\SUHVHUYHVH[XDOIXQFWLRQ$VD XURORJLFRQFRORJLVWRQHSULQFLSOHZKLFKPXVWQHYHU EHFRPSURPLVHGQHYHUWKHOHVVLVFRPSOHWHWXPRUH[ FLVLRQZLWKQHJDWLYHVXUJLFDOPDUJLQVDWWKHSULPDU\ WXPRUVLWHZKHUHE\HOLPLQDWLQJWKHQLGXVIRUFDQFHU GLVVHPLQDWLRQ DV ZHOO DV D SRWHQWLDO VLWH RI ORFDO V\PSWRPDWLFUHFXUUHQFH$VQHZVXUJLFDODQGWHFKQL FDODGYDQFHVEHLQJUHDGLO\DYDLODEOHLQRXUWUHDWPHQW DUPDPHQWDULXPZHPXVWHQVXUHWKDWFDQFHUVSHFL¿F RXWFRPHVRIWKHVHDSSURDFKHVPHHWWKHEHQFKPDUN ZHKDYHHVWDEOLVKHGLQWKHPDQDJHPHQWRIWKLVKLJKO\ DJJUHVVLYHWXPRUSKHQRW\SH
Dr. Philippe E. Spiess
0RI¿WW&DQFHU&HQWHU Tampa, Florida, USA (PDLO3KLOLSSH6SLHVV#PRI¿WWRUJ SDWLHQWVZLWKSHQLOHVTXDPRXVFHOOFDUFLQRPD-8URO
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'¶$QFRQD&$%RWHJD1-'H0RUDHV&/DYRXUD16 -U6DQWRV-.5RGULJXHV1HWWR1-U4XDOLW\RIOLIH after partial penectomy for penile carcinoma. Urology.
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Accepted after revision: October 15, 2009
Correspondence address: 'U)HUQDQGR.RUNHV 5XD3LUDSRUD
