Lichen sclerosus in patients with squamous cell carcinoma. Our experience with partial penectomy and reconstruction with ventral fenestrated flap.

INTRODUCTION: The vast majority of penile malignant tumors are squamous cell carcinomas (SCCs). After histological diagnosis of penile carcinoma, when possible, more conservative procedures are performed, otherwise it is necessary to perform a total penectomy.

MATERIAL AND METHODS: Ten patients, from 2006 to 2008, underwent to partial penectomy and reconstruction with ventral fenestrated flap technique; five of these patients had lichen sclerosus. All tumors were staged as T2N0M0, involving the corpus spongiosum and cavernosum. Patients were evaluated both the aesthetical and the sexual satisfaction, the first one by patient aesthetical self-assessment score, the second one by the International Index of Erectile Function (IIEF). Patients underwent follow-up for forty months.

RESULTS: Of the ten patients, no one encountered severe complications. The average aesthetic satisfaction one month postoperatively was of 2 points, 40 months postoperatively it was of 3 points (scoring scale: 1= complete dissatisfaction, 5 = complete satisfaction). The average IIEF score in the preoperative period was 21.6 points, one month postoperatively it was 13 points, 40 months postoperatively it was 19.7 points (mild erectile dysfunction).

DISCUSSION: The technique we presented, compared to other techniques, allows a reduction in operating time and is a one step technique without risk of non-engraftment. The ventral fenestrated flap technique did not result in metal stenosis in our ten patients series.

CONCLUSIONS: The use of a ventral fenestrated flap in the closure of the defect due to partial penectomy has numerous advantages. Aesthetics is highly accepted by patients who are satisfied and report satisfactory sexual activity despite the reduction in penis length.