International Journal of Impotence Research (2001) 13, 47±48
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Case Report
Penile resurfacing for extensive genital warts
A Ballaro*1, JJ Webster1 and D Ralph1
1
Institute of Urology and Nephrology, 48 Riding House Street, London, UK
Complete surgical excision followed by reconstruction, of diseased penile skin may result in
sexual dysfunction due to tethering of the underlying Buck's fascia by the graft. We describe penile
resurfacing for extensive condyloma accuminata, a novel technique that circumvents this
complication without compromising clearance of this particular lesion. International Journal
of Impotence Research (2001) 13, 47±48.
Keywords: penile reconstruction; penile resurfacing; condyloma accuminatum
Introduction
Condyloma accuminata are caused by the human
papilloma virus (HPV) and occur commonly on the
shaft of the penis.1 Treatment is aimed at their
removal, alleviation of symptoms, and reducing the
risk of transmission rather than cure as no therapy
has been shown to eradicate HPV.1 Surgical excision
followed by reconstruction, of skin involved by
extensive and bulky lesions is advisable to expedite
treatment and to avoid large areas of maceration and
secondary infection resulting from other treatment
modalities.2 We describe penile resurfacing; a novel
technique for the surgical management of extensive
penile warts.
Case report
A 68-year-old man presented with extensive, heavily keratinised genital warts involving the whole of
the penile skin apart from the glans, the corona and
a thin ventral bridge along the full length of the
penis (Figure 1). An area of suprapubic skin was
also involved. He had undergone unsuccessful
treatment with tropical podophyllin 10 years previously, and since then had allowed the warts to
proliferate untreated. Under general anaesthesia the
warts were carefully `shaved off' using a dermatome
blade (No. 12) until only visibly normal dermis
remained. The defect was covered with a fenestrated
split skin graft taken from the thigh. The suprapubic
*Correspondence: A Ballaro, Institute of Urology and
Nephrology, 48 Riding House Street, London, W1P 7PN, UK.
E-mail: [email protected].
Received 10 December 2000; accepted 2 January 2001
warts were excised together with the full thickness
of the underlying skin, and the defect closed using a
rotation ¯ap. The split skin graft `take' was uncomplicated, and an excellent cosmetic result was
seen at 6-month follow-up (Figure 2). The patient
reported normal penile sensation, unaffected erections and no sexual dysfunction.
Discussion
Split excision of diseased penile skin has not
previously been reported, and complete excision is
normally preformed. Reconstruction of the resulting
defect using a full-thickness skin graft is recommended for the potent patients,3 as contraction of
split skin grafts may lead to penile encasement and
sexual dysfunction. However, full thickness grafts
generally `take' less successfully than split skin
grafts, and this process is further compromised on
the penile shaft by the anatomical mobility and
delicate nature of Buck's fascia,4 which lies immediately deep to the skin. Furthermore, tethering
of this loose and mobile areolar tissue resulting from
direct exposure to the graft may lead to disturbance
of its principal function; to enable the free movement of penile skin over the underlying structures
during intercourse.5
Histologically, condyloma accuminata are con®ned to the epidermis6 and split thickness excision
of involved skin is therefore likely to result in their
complete removal. Preservation of the deeper dermis
allows it to provide an ideal bed for a split skin graft,
theoretically reducing the tendancy of the graft to
contract, and protects Buck's fascia from the direct
exposure to the healing process. The defect would
be expected to re-epithelialise spontaneously,
Penile resurfacing
A Ballaro et al
48
Figure 1 Pre-operative appearance (shaved) showing heavily
keratinised penile warts.
however we felt that skin grafting was necessary to
avoid a prolonged painful raw area on the penis, and
to improve cosmesis. Condyloma accuminata have
rarely been associated with squamous cell carcinoma,7 and a potential disadvantage of this technique
is the production of a macerated histological specimen. However, we believe that the cosmetic appearance and maintenance of erectile function resulting
from retained mobility of the penile skin using this
technique represents a considerable improvement
on standard procedure.
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International Journal of Impotence Research
Figure 2 Appearance 6-months after penile resurfacing. Note the
laxity of the penile skin.
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