Resection Of The Penoscrotal Web With Scrotal Interposition Flap

O. Shaeer, K.O.K.M. Shaeer Jr., K. Shaeer

peno-scrotal web, penoscrotal web, scrotal web, penis length enhancement, penile elongation

This video demonstrates resection of the penoscrotal web (PSW). The web is a skin flap that extends from the scrotum to the distal penis rather than to the peno-scrotal junction at the base of the penis. It can be congenital or iatrogenic. PSW can sometimes be esthetically unappealing. In rare cases, some patients may complain of failure to use the whole length of the penis, or scrotal pain due to mild trauma at intercourse. Resection of the PSW has been described in several publications1, 2. Care must be taken to not overly excise the web, otherwise skin shortage in girth and or length can issue, or the incision may heal with a wider scar due to closure under tension. We therefore prefer to operate in the erect state to properly evaluate the optimum extent of resection. We then prefer to preserve as much Dartos as possible to avoid poor healing, skin necrosis and edema. We reconstruct the peno-scrotal junction with a deep gathering Dartos stitch. We recommend layered closure to preserve the gliding property of penile skin at intercourse. While longitudinal closure along the median raphe is faster and is hidden within the natural line, we prefer to bring a scrotal flap up to the peno-scrotal junction to relieve wound tension at the point of widest resection. Z-plasty 3 and VY-plasty 4 are possible alternatives. In our opinion, they are more suited for smaller webs that do not require extensive resection. Dog-ears at the tips of the incision are commonly encountered and should be handled as shown.

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1. Bonitz RP, Hanna MK. Correction of congenital penoscrotal webbing in children: A retrospective review of three surgical techniques. Journal of Pediatric Urology. 2016;12: 161.e1-61.e5.

2. Carrion R. Ventral phalloplasty. J Sex Med. 2010;7: 2914-7.

3. Alter GJ. Surgical Techniques: Correction of Penoscrotal Web. The Journal of Sexual Medicine. 2007;4: 844-47.

4. Chang SJ, Liu SP, Hsieh JT. Correcting penoscrotal web with the V-Y advancement technique. J Sex Med. 2008;5: 249-50.