PMC8552933_01
The melanoma of the glans and meatus.
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A 50-year old healthy man presented with a brown irregular flat lesion surrounding the tip of the glans, involving the urethral meatus (Figure 1).
A. Excision of the glans and urethra. B. Harvesting of the internal preputial leaflet graft. C. The skin graft transposed from the flank to the dorsal tip of the corpora cavernosa. End of the first-stage surgery.
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The distal urethra was excised with a 1.5 cm safety margin, confirmed as healthy by a preliminary histological examination (Figure 2A). A dorsal transverse preputial flap was created, and a template-tailored free graft was harvested from the internal leaflet of the foreskin (Figure 2B). The skin graft was prepared separately by accurate defatting until achieving a thin thickness, meshed with scalpel, laid circularly for 180 degrees on the tip of the corpora cavernosa, and sutured with 4-zero polyglactin interrupted stitches (Figure 2C).
A. The 6 months outcome of first-stage surgery. B. The neo-urethra tubularized using the preputial plate. C. End of the second-stage surgery.
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The second-stage surgery was planned after 6 months at consolidated first-time reconstruction (Figure 3A). The plate of preputial graft was incised along its edges and tubularized using a running 5-zero polyglycolic suture upon a 14 Fr catheter (Figure 3B). A dartos tail was used to cover the neourethra to protect the suture, and then the shaft was covered with a tension-free penile skin flap (Figure 3C).
The reconstructed glans and urethra at 24 months.
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At 24 months after the second-stage surgery, the urethra was shown to be negotiable by a 16 Fr catheter (Figure 4).