For some patients, surgery may be an option to correct problems that can lead to loss or disease of the genital skin. Our urological specialists are experts in treating and correcting these conditions. Problems that can lead to genital reconstruction surgery may include, Fournier’s gangrene, lymphedema, excessive weight gain, and complications caused from injections or ill-advised penile enhancements.
Particularly in diabetic men, life-threatening infections can occur that affects the skin of the penis, scrotum, anus, and perineum (the area between the anus and the scrotum). Patients often become very ill with high fevers and emergency surgery is needed to remove the infected skin, in order to save the patient’s life. After surgery there is a large defect in the area where the skin was removed. The underlying structures and tissue of the penis and testicles is exposed when the skin is removed and needs to be repaired. This problem is best repaired with skin flaps or grafts placed over the testicles and the penis. Skin grafts are usually taken from the thigh or the abdomen. Sometimes the testicles are placed into pouches made in the thigh to protect them if a skin graft cannot be fashioned to cover them. The recuperation from this problem can take some time and patients are often best treated in a hospital with a burn intensive care unit since treatment of the skin problem is very similar to the treatment of a serious burn.
Lymphedema refers to swelling of the genital skin. This swelling is the result of damage to the lymph channels leading away from the genitals. This damage to the lymph channels can be caused by chronic infection, radiation or previous surgeries. The condition leads to painful swelling of the skin surrounding the genitals and may act to obstruct normal sexual and urinary function. The affected skin often has a doughy appearance from accumulation of excess fluid that is normally drained by the lymph channels. The treatment for this condition, when it does not respond to simple medicines such as a pill to remove excess fluid, is surgical removal of the skin and skin grafting of the penis and scrotum.
There are many patients that undergo ill-advised surgery to enhance the length or width of the penis. These surgeries are rarely successful and can lead to severe complications. One of these common procedures is to inject material along the shaft of the penis to increase the girth or width of the penis. The types of material used to inject the penis range from fat cells to silicone material. This material can lead to chronic swelling and pain in the skin of the penis or to very hardened abnormal scarring surrounding the penis and scrotum. The result is debilitating and leads to chronic pain and sexual dysfunction. Usually in order to reconstruct this problem the foreign material needs to be removed along with the skin that is involved in the scarring or inflammation. Sometimes skin grafts need to be performed when a large amount of the skin is involved with infection or scarring.
Many men when they gain weight feel that their penis shrinks. This is not what actually happens. The penis is anchored to the pubic bone and as men gain weight the fat pad above the pubic bone grows and surrounds the penis covering it up and making it appear to shrink. If the situation is serious enough than it can lead to problems with urination and sexual function. The penis appears to be dramatically retracted and the head of the penis cannot be exposed to allow for urination. This leads to a lot of chronic irritation and discomfort from urinary spraying. This is a difficult problem but can be treated by either weight loss or surgery. Surgery involves removal of the fat pad overlying the penis. This is called a panniculectomy. The penile skin is often chronically infected and in some cases this needs to be removed and patients needs a skin graft placed around the shaft of the penis. This surgery is not easy but can resolve this problem if weight loss is not feasible.