User:Pnguyen12/Scrotoplasty
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Scrotoplasty, also known as oscheoplasty, is a form of male genital plastic surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. [1] However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. [1] There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.
Reasons for a getting a Scrotoplasty
Buried Penis and Penoscrotal Webbing
Buried penis is a condition when the penis is attached to their scrotum with an excess of skin. This condition can affect both newborn and adult males. Scrotoplasty can be performed to remove the extra skin in the scrotal area and reshape their scrotum. Penoscrotal webbing is another condition, where the skin connecting the penis to the scrotum extends along the underside of the penis shaft like a web. [2] This condition is easily confused with buried penis. Both conditions affect newborn and adult males but they do not always require surgery. Scrotoplasty can be considered to remove excess skin in order to restore normal appearance of their scrotum and penis length, which can improve a man's confidence. In both conditions, the scrotoplasty procedure involves making an incision in the fused part between the penis and scrotum and then reconstructing the scrotum.[2]
Female-to-Male Transition
Some trans men and intersex or non-binary people who were assigned female at birth may choose to have gender-affirming surgeries to create male genitals from existing tissue, as part of their female-to-male transition.[3] There are two types of gender-affirming surgeries, metoidioplasty and phalloplasty. In both of these surgeries, a scrotoplasty can be considered as an additional surgery to add testicular implants.[4] Metoidioplasty involves modification of the clitoris into a penis. Generally, the clitoris is hormonally enlarged with testosterone, making it possible for it to be straightened and lengthened into a penis. Outcomes of this surgery include the ability to urinate while standing and retain sexual stimulation.[4] Phalloplasty is the other type of surgery to create a penis, but utilizes skin from other areas of the body besides existing genitals. The most common part of the body used in this surgery is the forearm and has the same outcomes as a metoidioplasty.[5] The addition of a scrotoplasty with implants is an optional procedure for individuals to choose based on their goals with their transition. Deciding if a scrotum meets their needs in their transition is a consideration for adding a scrotoplasty procedure.[4][5]
Fournier's Gangrene, Trauma, and Cancer
There are various categories of injuries to the scrotum that result in the loss of scrotal skin tissue. Scrotoplasty in these conditions is to remove necrotic skin and reconstruct the scrotum.
The first category of scrotal injury includes Fournier's Gangrene, which is a necrotic infection of the soft tissue around the genital. This infection is commonly caused by a poly microbic flora in the individuals who has co-morbidities such as immunocompromised conditions, diabetes mellitus, colorectal infection. To stop the necrotizing fasciitis from spreading, the treatment requires an aggressive surgical debridement which results in the loss of the scrotal skin. After the patient is stable and cleared from the infection, scrotal reconstruction is needed to restore its function the scrotum.[6]
The second category of scrotal injury includes trauma to the scrotum, such as from burns, machinery accidents, traffic accidents, firearm accidents, and surgical accidents.[7] People who experience these injuries may require scrotoplasty if they lose more than 50% of their skin.[8][9] Reconstructing scrotal skin can be accomplished by using skin grafts from other areas of the body. Tissue expansion, a procedure in which the skin is stretched to regenerate new cells, can also be an option in order to restore scrotal skin loss.
Cancer that affects the scrotum and requires removal of tissue may also require scrotoplasty to repair the scrotum.[10]
Excess Skin
There are many reasons that can cause scrotal sagging such as natural aging, varicocele, hydrocele, and cancer patients. Scrotoplasty, in particular scrotal lift, is an option to remove excess loose scrotal skin, tighten, and reduce the size of the scrotum in order to reduce discomfort and improve appearance.
Procedure
Pre-Operation
Candidates must avoid any nicotine products, which can potentially affect wound healings and perioperative complications, for 3 months prior to the surgery. People must also be screened for other contraindications, including obesity with specific adipose distribution. Diabetes can also lead to wound complications such as wound separation or wound disruption.[11] Other contraindications exist for specific types of phalloplasty. For instance, BMI of greater than 35 kg/m2 is contraindicated for radial forearm free flap (RFFF) phalloplasty, a total body weight that is anything other than ideal body weight is not recommended for metoidioplasty and anterolateral thigh (ALT) phalloplasty.[12]
For gender-affirming scrotoplasty, people should have already been receiving hormone therapy for over 1 year with established mental and primary health care. Some transmasculine people have already undergone double mastectomy and hysterectomy. Scrotoplasty for transmasculine individuals is usually done with other GRGUS (gender-related genitourinary surgery), which consists of various procedures with variable personal desires for metoidioplasty, phalloplasty, vaginectomy, and urethroplasty.[12] A comprehensive history and physical assessment of the physical sites are taken during consultation to identify the candidates' surgical goals, which then help determine which procedures are needed.
During Operation
Post-Operation
Complications and Risks
People who are candidates for angioplasty need to be educated on the associated risks and complications before the procedure. Complications to scrotoplasty primarily deal with testicular implants. If they are too big, there is chance that the implants could feel uncomfortable, or be a cause of chronic pain.[13] Another complication is that the implant could erode the skin of the scrotum. This can cause infection, or an abnormal connection between two body parts (a fistula) where the implant may work its way outside the body.[13]
There have been advancements in the surgical techniques. However, the risk of recurrent condition still exists. In addition, the cosmetic results might not be satisfactory to some people after surgery. [14] Another factor to consider is the loss of sensation in the scrotal area due to the nature of the procedure which can involve removal of genital tissues.[14]
Other complications are those that are typical for any surgery, such as blood loss, infection, or problems with anesthesia.
References:[15]
- ^ a b Zaccaro, Claudia; Subirà, David; López-Diez, Iñigo; Manfredi, Celeste; Ascensios-Vargas, Julmar Paul; Moncada-Iribarren, Ignacio (2022). "History and future perspectives of male aesthetic genital surgery". International Journal of Impotence Research. 34 (4): 327–331. doi:10.1038/s41443-022-00580-6. ISSN 0955-9930.
- ^ a b Lucas, Jacob W.; Lester, Kyle M.; Chen, Andrew; Simhan, Jay (2017). "Scrotal reconstruction and testicular prosthetics". Translational Andrology and Urology. 6 (4): 710–721. doi:10.21037/tau.2017.07.06. PMC 5583055. PMID 28904904.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Frey, Jordan D.; Poudrier, Grace; Chiodo, Michael V.; Hazen, Alexes (2017). "An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature". Plastic and Reconstructive Surgery. 139 (3): 728–737. doi:10.1097/PRS.0000000000003062. ISSN 0032-1052.
- ^ a b c Djordjevic, Miroslav L.; Stojanovic, Borko; Bizic, Marta (2019). "Metoidioplasty: techniques and outcomes". Translational Andrology and Urology. 8 (3): 248–253. doi:10.21037/tau.2019.06.12. PMC 6626308. PMID 31380231.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ a b Heston, Aaron L.; Esmonde, Nick O.; Dugi III, Daniel D.; Berli, Jens Urs (2019). "Phalloplasty: techniques and outcomes". Translational Andrology and Urology. 8 (3): 254–265. doi:10.21037/tau.2019.05.05. PMC 6626313. PMID 31380232.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Schifano, Nicolò; Castiglione, Fabio; Cakir, Onur Omer; Montorsi, Francesco; Garaffa, Giulio (2022). "Reconstructive surgery of the scrotum: a systematic review". International Journal of Impotence Research. 34 (4): 359–368. doi:10.1038/s41443-021-00468-x. ISSN 0955-9930.
- ^ McGeady, James B.; Breyer, Benjamin N. (2013). "Current Epidemiology of Genitourinary Trauma". Urologic Clinics of North America. 40 (3): 323–334. doi:10.1016/j.ucl.2013.04.001. PMC 4016766. PMID 23905930.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Lucas, Jacob W.; Lester, Kyle M.; Chen, Andrew; Simhan, Jay (2017). "Scrotal reconstruction and testicular prosthetics". Translational Andrology and Urology. 6 (4): 710–721. doi:10.21037/tau.2017.07.06. PMC 5583055. PMID 28904904.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Normal and Abnormal Scrotum. doi:10.1007/978-3-030-83305-3.
- ^ Por, Yong-Chen; Tan, Bien-Keem; Hong, Soo-Wan; Chia, Sing-Joo; Cheng, C. W. S.; Foo, Chee-Liam; Tan, Kok-Chai (2003). "Use of the Scrotal Remnant as a Tissue-Expanding Musculocutaneous Flap for Scrotal Reconstruction in Pagetʼs Disease:". Annals of Plastic Surgery. 51 (2): 155–160. doi:10.1097/01.SAP.0000058501.64655.31. ISSN 0148-7043.
- ^ Gupta, Nikhil K.; Sulaver, Randy; Welliver, Charles; Kottwitz, Michael; Frederick, Luke; Dynda, Danuta; Köhler, Tobias S. (2019-04). "Scrotoplasty at Time of Penile Implant is at High Risk for Dehiscence in Diabetics". The Journal of Sexual Medicine. 16 (4): 602–608. doi:10.1016/j.jsxm.2019.02.001. ISSN 1743-6109. PMID 30852109.
{{cite journal}}: Check date values in:|date=(help) - ^ a b Djordjevic, Miroslav L.; Stojanovic, Borko; Bizic, Marta (2019). "Metoidioplasty: techniques and outcomes". Translational Andrology and Urology. 8 (3): 248–253. doi:10.21037/tau.2019.06.12. PMC 6626308. PMID 31380231.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ a b Laura Erickson-Schroth, ed. Trans Bodies, Trans Selves: A Resource for the Transgender Community. Oxford University Press, 2014. P. 282.
- ^ a b Pestana, Ivo A.; Greenfield, Jason M.; Walsh, Mark; Donatucci, Craig F.; Erdmann, Detlev (2009-10). "Management of "Buried" Penis in Adulthood: An Overview:". Plastic and Reconstructive Surgery. 124 (4): 1186–1195. doi:10.1097/PRS.0b013e3181b5a37f. ISSN 0032-1052.
{{cite journal}}: Check date values in:|date=(help) - ^ Li, Yuan; Zhu, Xiaoyu; Feng, Dongchuan; Gong, Jinchao; Sun, Guangyao; Zhang, Xilun; Hu, Dianhe; Sha, Suoyou; Han, Tao (2020-09-11). "A Modified Scrotoplasty for Treating Severe Penoscrotal Webbing in Children". Frontiers in Pediatrics. 8: 551. doi:10.3389/fped.2020.00551. ISSN 2296-2360. PMC 7533638. PMID 33072658.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)