Penile Preserving Vaginoplasty

Dr Kenneth Pollack, Consultant Plastic Surgeon and Professor of Surgery at the University Medical School, London, England

Infertility can be treated successfully with traditional laparoscopic techniques for men. As with treatment for other conditions, some men have problems achieving an adequate reduction of their enlarged penises, which results in impotence, incontinence and other maladies.

Dr Pollack prefers direct microsurgery. He has used this more recently with success. Dr Pollack places great emphasis on the gentle approach and his approach in difficult procedures is less forceful and more non-confrontational than conventional techniques; he prefers this to be achieved with minimal discomfort.

The surgery is performed under general anaesthetic, normally only 10-12 hours duration.

Complete PES Vaginoplasty

The surgical procedure consists of an extra-renalised split-and -cut technique in which the patient is given local and general anaesthesia.

The patient is placed in the recovery room before receiving another general anaesthetic and his penile length can be reduced by 25-30% overnight. The operation may take a further one to 12 hours.

Potential complications

Problems associated with the surgical operation are rare (although frequent associated with radical prostatectomy) and are often addressed before the operation is performed.

Initial problems are urinary stream and infection of the cutting line, although this is not associated with a significant morbidity.

Complications are very rare if undertaken with the skill and dedication of an expert surgeon.

These include recurrent infection, blockage and granulomas leading to fistula formation, perforations occurring in the form of haemorrhage, or damage to the urethra through which there may develop a scrotal-fistulodenal fistula.

Other less common problems include nerve damage to the scrotum, partial or total loss of continence and sexual impairment.

Conclusion

The benefits of the surgery are greater than the risks, and all patients are provided with further information and support by their GP or urologist.

The operation is a viable treatment option for men with severe impotence.