Genital Reconstruction

Genitals are sex organs present in the pelvic region. They are divided into external and internal genitals. External genitals in men include the penis and scrotum, while the internal genitals include the testes, seminal vesicles, prostate gland, ejaculatory ducts and urethra. The external genitals in women include the vulva, clitoris, labia, and the opening of the vagina and urinary bladder. Genital reconstruction is a surgical procedure performed to remove diseased tissues of the genital region and restore its normal structure and function.

Indications

Indications for genital reconstruction in males include:

  • Reconstruction of penis and scrotum in cases of genital cancers, trauma, congenital deformities and Peyronie’s disease (curved or bent penis).
  • Damage caused due to conditions such as lymphedema (swelling of genital skin due to damaged lymph channels), complications of penile enhancement surgeries, excessive weight gain causing hidden penis, or Fournier’s gangrene (genital infection).

Indications for genital reconstruction in females include:

  • Correcting deformities of the genitals after cancer surgery, birth defects (absence of the vagina or intersex), female "circumcision" and traumas.

Reconstruction is also indicated for treating urethral injuries, urinary incontinence, and fistulas (abnormal connection between two structures) caused by surgery or radiation in both men and women.

Reconstruction of the male genitals

Conditions such as severe infection and lymphedema affect the underlying structures of the genitals. This creates large defects and requires the removal of diseased skin and underlying tissues around the genitals. These defects are repaired with skin flaps or grafts obtained from the thigh or abdomen.

Reconstruction also treats hardened scars and painful swelling around the penis and scrotum caused due to penis enhancement procedures. Your surgeon removes the foreign material used in the enhancement procedure and any scarred skin, and reconstructs the organs with skin grafts. A distorted appearance of the penis due to excessive weight gain can also be corrected by removing the excess fat tissue (panniculectomy) overlying the penis or infected tissue around the penis, and replacing it with skin grafts.

Reconstruction of the female genitals

Female genital tract reconstruction may involve simple procedures such as split-thickness skin grafts (skin grafts with the underlying layers of the skin) or complicated ones such as the use of skin and muscle flaps.

Vulvar and perineal (region between the anus and vulva) reconstruction may include the following techniques:

  • Split-thickness skin grafting: Your surgeon may remove the vulvar skin (skinning vulvectomy), preserving the underlying tissues and blood supply. Following this, split-thickness skin grafting is performed, which involves the removal of the top two layers of healthy skin from another part of your body and implanting it at the region of disease.
  • Full-thickness graft: Full-thickness grafts are usually used to correct surgical complications such as vulvar scars, infections and narrowing of the vulva.  An entire thickness of skin, with underlying muscle and blood supply from a donor site is used in this type of graft. Small grafts are obtained from the groin, upper thigh or the labia minor (inner flap of skin that covers the vaginal opening).
  • Labial pedicle flap: A flap of skin and underlying blood supply from the adjacent healthy skin from the labial region is used to reconstruct tissue death (necrosis), ulceration, fistulas and other problems that could result due to radiation therapy of the female genital region.

Vaginal reconstruction may be performed to correct deformities that can occur because of the surgical removal of parts of the vagina, radiation therapy, and presence of fistulas. The choice of reconstructive surgery depends on the extent of vaginal tissue remaining. Various types of grafts used for vaginal reconstruction include:

  • Split-thickness skin grafting: Skin graft from the abdomen, buttocks or thigh is used to reconstruct the vagina. In addition, a vaginal stent (sealed silicone shell that takes the shape of the vagina) may be inserted for a period to maintain the shape of the newly formed vagina and prevent it from contracting.
  • Omental grafts: The peritoneum (tissue that lines most of the abdominal organs) from the bladder and rectum is extended and attached to the vaginal ends to extend the length of the vagina by at least 2 to 3 cm.
  • Large and small bowel grafts: Vaginal tube is created with an intestinal loop.
  • Bladder segment grafts: Bladder segment is used to create an upper vagina.
  • Myocutaneous flaps: Thigh or abdominal muscle and skin flap is used to create a new vagina.

Malignant tumors of the urethra are removed by excising the part of the urethra closest to the outside of the body. Some cases may require reconstruction to lengthen the distal urethra with the use of genital tissue grafts. Your surgeon will create a tube-like structure to extend the shortened urethra.

Post-operative care

Following the surgery, ensure that you empty your bladder every 2 to 3 hours and avoid over distension of the bladder. Avoid constipation and have warm salt water baths to reduce vaginal pain and discomfort. Follow-up pelvic and urine examinations will be conducted a few weeks after the surgery. Avoid lifting heavy objects and sexual intercourse for a few weeks. Immediately inform your doctor if you experience foul smelling green or watery discharge.

Risks and Complications

As with any surgery, genital reconstruction involves certain risks and complications. They may include:

  • Necrosis or death of the graft
  • Narrowing or loss of vaginal flexibility
  • Formation of fistulas between the vagina and bladder or rectum
  • Vaginal dryness
  • Vaginal prolapse (weakening of muscles around the vagina)
  • Infection
  • Blockage or leakage in the constructed urethral passage
  • Reduced blood supply to the new region
  • Fibrosis (scarring) at the operative site
  • Damage to associated nerves and blood vessels