Evaluation of the ventral phalloplasty technique for adult penoscrotal web and scrotal laxity repair using the male genital self-image scale, Beck depression inventory, and International index of erectile function

Evaluación de la técnica de faloplastia ventral en la corrección de la membrana penoscrotal y la laxitud escrotal en adultos mediante la escala de autoimagen genital masculina, el inventario de depresión de Beck y el índice internacional de función eréctil

Background: Ventral phalloplasty is a reconstructive procedure used to correct penoscrotal webbing and excessive scrotal laxity, both of which may negatively affect genital appearance, patient comfort, and sexual satisfaction. This study aimed to evaluate the effectiveness of ventral phalloplasty in the repair of adult penoscrotal webbing (PSW) and scrotal laxity by analyzing outcomes using Male Genital Self-Image Scale (MGSIS-7), Beck Depression Inventory (BDI), and International Index of Erectile Function (IIEF-15). Methods: Data from 54 patients diagnosed with PSW and scrotal laxity in our clinic between 2012 and 2022 who underwent repair using the ventral phalloplasty technique were retrospectively evaluated. Demographic variables, including age, operative time, web grade, body mass index (BMI), and postoperative complications, were recorded. In addition, each patient was assessed using the BDI, IIEF-15, and MGSIS-7 scales. Results: The mean age and operative time were 31.8 ± 5.57 years and 47.1 ± 4.82 minutes, respectively. Demographic variables such as age, operative duration, web grade, BMI, and postoperative complications were comparable across patients (p > 0.05). However, comparisons of BDI, IIEF-15, and MGSIS-7 scores revealed statistically significant differences (p < 0.05). Conclusions: Evaluation of the ventral phalloplasty technique in adults undergoing PSW and scrotal laxity repair, using MGSIS-7, BDI, and IIEF-15, demonstrated positive effects on both functional and aesthetic outcomes.

Resumen

Antecedentes: La faloplastia ventral es una intervención reconstructiva que se utiliza para corregir la membrana penoscrotal y la laxitud escrotal excesiva, dos afecciones que pueden afectar negativamente al aspecto genital, al bienestar del paciente y a la satisfacción sexual. El objetivo de este estudio fue evaluar la eficacia de la faloplastia ventral en la reparación de la membrana penoscrotal (PSW) y la laxitud escrotal en adultos, mediante el análisis de los resultados utilizando Escala de Autoimagen Genital Masculina (MGSIS-7), Inventario de Depresión de Beck (BDI) y Índice Internacional de Función Eréctil (IIEF-15). Métodos: Se evaluaron retrospectivamente los datos 54 pacientes diagnosticados con PSW y laxitud escrotal en nuestra clínica entre 2012 y 2022, a los que se les practicó una reparación mediante la técnica de faloplastia ventral. Se registraron variables demográficas, como la edad, la duración de la intervención, el grado de la membrana, el índice de masa corporal (IMC) y las complicaciones posoperatorias. Además, se evaluó a cada paciente mediante las escalas BDI, IIEF-15 y MGSIS-7. Resultados: La edad media y la duración de la intervención fueron de 31.8 ± 5.57 años y 47.1± 4.82 minutos, respectivamente. Las variables demográficas, como la edad, la duración de la intervención, el grado de la membrana, el IMC y las complicaciones posoperatorias, fueron comparable entre los pacientes (p > 0.05). Sin embargo, las comparaciones de las puntuaciones del BDI, el IIEF-15 y el MGSIS-7 revelaron diferencias estadísticamente significativas (p < 0.05). Conclusiones: La evaluación de la técnica de faloplastia ventral en adultos sometidos a reparación de la membrana penoscrotal y laxitud escrotal mediante MGSIS-7, el BDI y el IIEF-15, demostró efectos positivos tanto en los resultados funcionales como en los estéticos.

Penoscrotal web; Scrotal laxity; Ventral phalloplasty; Genital self-image; Erectile dysfunction; Depression

Palabras Clave

Membrana penoscrotal; Laxitud escrotal; Faloplastia ventral; Autoimagen genital; Disfunción eréctil; Depresión

[1] Thomas C, Navia A. Aesthetic scrotoplasty: systematic review and a proposed treatment algorithm for the management of bothersome scrotum in adults. Aesthetic Plastic Surgery. 2021; 45: 769–776.

[2] El-Koutby M, El Gohary MA. Webbed penis: a new classification. Journal of Indian Association of Pediatric Surgeons. 2010; 15: 50–52.

[3] Schifano N, Castiglione F, Cakir OO, Montorsi F, Garaffa G. Reconstructive surgery of the scrotum: a systematic review. International Journal of Impotence Research. 2022; 34: 359–368.

[4] Cohen PR. Genital rejuvenation: the next frontier in medical and cosmetic dermatology. Dermatology Online Journal. 2018; 24: 3.

[5] Fuller TW, Theisen K, Rusilko P. Surgical management of adult acquired buried penis: escutcheonectomy, scrotectomy, and penile split-thickness skin graft. Urology. 2017; 108: 237–238.

[6] Beck AT, Steer RA, Ball R, Ciervo CA, Kabat M. Use of the Beck anxiety and depression inventories for primary care with medical outpatients. Assessment. 1997; 4: 211–219.

[7] Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997; 49: 822–830.

[8] Sonbahar AE. The impact of male genital self-image on depression, anxiety and sexual functions. The Aging Male. 2024; 27: 2363275.

[9] Koçak V, Erkal Aksoy Y, Dügeroğlu S. Turkish validity and reliability study of male genital self-image scale (MGSIS). Urologia. 2023; 90: 278–285.

[10] Caso J, Keating M, Miranda-Sousa A, Carrion R. Ventral phalloplasty. Asian Journal of Andrology. 2008; 10: 155–157.

[11] Lucas JW, Lester KM, Chen A, Simhan J. Scrotal reconstruction and testicular prosthetics. Translational Andrology and Urology. 2017; 6: 710–721.

[12] Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. The Journal of Sexual Medicine. 2007; 4: 1494–1499.

[13] Bagnara V, Donà A, Berrettini A, Castagnetti M, Paraboschi I, Messina M, et al. The “V-I penoscrotal reconfiguration”: a simple technique for the surgical treatment of congenital webbed penis. International Journal of Urology. 2024; 31: 886–890.

[14] Koçak V, Tufan O. Male genital self-image, premature ejaculation, and affecting factors. Sexual Medicine. 2024; 12: qfae041.

[15] Selino S, Krawczyk R. Happiness with circumcision status, not status itself, predicts genital self-image in a geographically diverse sample. Archives of Sexual Behavior. 2023; 52: 1525–1534.

[16] Herbenick D, Schick V, Reece M, Sanders SA, Fortenberry JD. The development and validation of the male genital self-image scale: results from a nationally representative probability sample of men in the United States. The Journal of Sexual Medicine. 2013; 10: 1516–1525.

[17] Saffari M, Pakpour AH, Burri A. Cross-cultural adaptation of the male genital self-image scale in Iranian men. Sexual Medicine. 2016; 4: e34–e42.

[18] Czajkowski M, Czajkowska K, Zarańska K, Giemza A, Kłącz J, Sokołowska-Wojdyło M, et al. Male circumcision due to phimosis as the procedure that is not only relieving clinical symptoms of phimosis but also improves the quality of sexual life. Sexual Medicine. 2021; 9: 100315.

[19] Sanches BC, Laranja WW, Alonso JC, Rejowski RF, Simões FA, Reis LO. Does underestimated penile size impact erectile function in healthy men? International Journal of Impotence Research. 2018; 30: 158–162.

[20] Shapurian R, Hojat M, Nayerahmadi H. Psychometric characteristics and dimensionality of a Persian version of Rosenberg self-esteem scale. Perceptual and Motor Skills. 1987; 65: 27–34.

[21] Veale D, Miles S, Bramley S, Muir G, Hodsoll J. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU International. 2015; 115: 978–986.

[22] Soubra A, Natale C, Brimley S, Hellstrom WJG. Revelations on men who seek penile augmentation surgery: a review. Sexual Medicine Reviews. 2022; 10: 460–467.

[23] de Arruda GT, da Silva EV, Braz MM. Male genital self-image scale (MGSIS): cutoff point, cultural adaptation and validation of measurement properties in Brazilian men. The Journal of Sexual Medicine. 2021; 18: 1759–1767.

[24] Tal R, Nabulsi O, Nelson CJ, Mulhall JP. The psychosocial impact of penile reconstructive surgery for congenital penile deviation. The Journal of Sexual Medicine. 2010; 7: 121–128.

[25] Zachalski W, Krajka K, Matuszewski M. Evaluation of the treatment of congenital penile curvature including psychosexual assessment. The Journal of Sexual Medicine. 2015; 12: 1828–1835.