Glans resurfacing is a newly described method in the management of superficial invasive tumors and precancerous lesions of the glans penis as well as indolent persistent lichen sclerosus cases. The method is complex and is generally only done in specialized centers with mutual work urological and plastic surgical expertise.
Cosmetic and functional results are improved than more extensive penile operation like glansectomy, in such cases, cancer cure and control is similar. Knowledge about the method used and the spectrum of disease are crucial for correct specimen handling and pathological reporting of such complex cases to aid in further management and to avoid over reporting of positive margins.
In some chosen cases of both benign, premalignant or malignant penile lesions, for normal and functional appearing penis the glans resurfacing or reconstruction may assured, without jeopardizing cancer control.
PROCEDURE:
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The method is appropriate for both circumcised and uncircumcised organs. In uncircumcised penis extending from the glans onto the inner foreskin and so the foreskin is excised in connection with the glans mucosa it is frequently observed.
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Partial resurfacing will also be undertaken for superficial lesions which are localized. The glans surface was marked by the doctor into 4 quadrants radiating out from the meatus to the coronal sulcus. The glans mucosa is dissected between the sub-epithelial tissues and corpus spongiosum even though small areas of corporal tissue are seen attached to the specimen which thickness id measured is 0.5-2mm.
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The foreskin is resected in continuity if it is present; or else a rim in coronal tissue from the area of the sulcus 3-5mm in width was taken. Then the defect was repaired by using a split skin graft from the thigh.
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Specimen was taken from the coronal ring and foreskin if present by that it can be compressed out and stitched to a rigid plastic sheet to aid orientation and fixation similar to the method used to fixation of a foreskin in cancer and precancer cases.
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Anatomical landmarks were marked by sutures and they were separate by biopsy or resection of the true urethral margin was taken. Separate biopsies may be taken of suspicious margins.
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In partial glans resurfacing the unusual area is excised from the glans as one or more quadrants by using alike method with or without removing the part of the foreskin. Acetic acid staining was used intraoperatively to define the abnormal area. Separate biopsies any suspicious glans margin may also taken.
