Per appuntamenti:

+39 3358151911

Indirizzi:

Gyplast Medical Institute - Viale Luigi Majno, 18

Milano

Clinica Planas - Av. Pere II de Montcada, 16

Barcelona

Clinique Champel - Rue Firmin Massot, 12

Ginevra

Email:

info@massimilianobrambilla.it

Genital Surgery

Hypospadias and epispadias

Externally, the penis is composed of 5 segments: base, shaft, foreskin, corona, and glans. It is distinguished into a free part and a fixed (perineal) part, also called the root of the penis; the free part consists of a cylindrical portion (body) and a conical one (glans). The skin covering it is loose and extends onto the glans with a portion of skin called the foreskin, which adheres to the glans in the middle through a ligament, the frenulum, which is attached to the urethral meatus. The penis has three cavernous bodies, two upper and one lower (spongy body) that are directly connected to the venous system.

Psychological Aspects

Highlighted in the XII Andrology Congress held in Milan in September 2006, about 20,000 Italians annually consult andrologists to inquire about penis lengthening methods. Of these, only 4% actually need it; the others desire it purely for aesthetic reasons. Many of those who anatomically do not need it fall into a psychological category defined by psychologists as “body dysmorphic disorder,” a lack of acceptance of one’s own body or parts of one’s own body.

When to intervene and when to say "NO!"

The careful, professional, and ethical specialist knows how to distinguish between a condition of anatomical alteration and one of exclusive psychological discomfort. In the first case, surgical solutions will be proposed, while in the second case, the specialist will refrain and may refer the patient to a psychosexual therapist to assess the real distress. There are indeed cases of “dismorphophobia” in patients with normal anatomy who may benefit from the surgical procedure solely for psychological reasons and not anatomical ones. Therefore, avoid falling into the hands of those who would exploit your distress for mere gain.

Morphological anomalies

Hypospadias

It is the anatomical condition in which the external urethral meatus is located on the ventral surface of the penis but in an abnormal position. Depending on the meatus’s position, hypospadias takes different names: balanic, balano-preputial, of the shaft, scrotal. In many cases, it is associated with curvature of the shaft. The surgical correction involves urethral reconstruction (feasible through various methods) associated with the correction of any curvature if present. Often, multiple surgical stages are necessary to achieve a functionally and cosmetically valid result.

Epispadias

It is the anatomical condition in which the external urethral meatus is located on the dorsal surface of the penis. It is often associated with curvature of the shaft and urinary incontinence. The surgical correction involves urethral reconstruction (feasible through various methods) associated with curvature correction. Often, multiple surgical stages are necessary to achieve a functionally and cosmetically valid result.

Frenulum breve

It is a quite common pathology. In most cases, it resolves spontaneously due to its tearing during the first sexual intercourses. In some cases, however, a small surgical procedure is necessary, consisting of frenulum release, a procedure that can be performed under local anesthesia, sometimes even with the application of a topical anesthetic ointment.

Phimosis

Phimosis is caused by the narrowing of the foreskin, the skin covering the glans. It can be congenital, as sometimes seen in children, or acquired due to infections or benign skin conditions (the most common being called lichen sclerosus) or, more rarely, malignant conditions.

The narrowing of the foreskin prevents the glans from being uncovered, leading to various issues:

Poor hygiene and the development of infections (balanoposthitis).
Difficulty in sexual intercourse.
Challenging urination and urinary obstruction (in more severe cases).

The surgical treatment involves the foreskin’s detensioning. The procedure can be done under local or local with sedation anesthesia, preceded by the application of a potent anesthetic ointment to minimize the sensation of the fine needle used to inject the local anesthetic.

There are two surgical techniques:

Circumcision: This is the simplest and most widely used technique, involving the complete removal of the foreskin.
Detension through multiple plastic surgery: This procedure is often recommended by skilled plastic surgeons as it resolves phimosis without resorting to foreskin removal. It involves detensioning the tight ring with a series of tiny incisions along the penile corona. This results in an “elastic” scar.

The postoperative course is rapid, characterized by minimal swelling. Sexual intercourse should be avoided for a month.

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