Refashioning of phallus stumps and phalloplasty in the treatment of carcinoma of the penis.

The surgical management of 41 patients with carcinoma of the penis is presented. Conservative surgery in the form of a circumcision or a glansplasty was done in eight patients with one recurrence. Circumcision as an adequate procedure is advocated for lesions near the apex of the preputial sac permitting a 2 cm clearance; glansplasty after local excision requires further evaluation. The details of technique of lengthening and refashioning of the residual phallic stump after partial amputation in a further 20 patients is described using a technique which leaves a satisfactory penile stump in patients who would normally be candidates for a total amputation. In a third group of patients requiring a total amputation of penis, reconstruction was done in two stages using scrotal flaps in four with satisfactory results. The reconstructed phallus was adequate as a urinary conduit but was unsuitable for sexual function. A one stage procedure involving covering of the urethra with scrotal flaps appears an attractive alternative to the staged procedure. Conventional multistage reconstructions are not recommended.