Microsurgical penile revascularization, replantation, and reconstruction

Microsurgery, in a general sense, can be defined as surgery with optical enhancement. Certainly, nuances with regard to various specialties and their respective domain’s microsurgical procedures exist. In the field of urology, urologists initially were exposed to microsurgery as it related to male–factor fertility (Silber, Urology 6:150–3, 1975), such as vasovasostomy, vasoepididymostomy, and microsurgical scrotal and groin explorations. However, just as the field of andrology encompasses fertility issues as well as erectile dysfunction, so too does microsurgery have applications in the latter. Microsurgical techniques have formed an essential component of penile revascularization and venous surgery for erectile dysfunction in a select group of patients (Crespo et al., Urology 20:271–5, 1982; Goldlust et al., J Urol 128:821–2, 1982; Goldstein et al., J Sex Med 5:2018–21, 2008; Munarriz, ScientificWorldJournal 10:1–9, 2010; Munarriz et al., J Urol 182:643–8, 2009; Montague et al., The management of erectile dysfunction: an update. Baltimore, MD: American Urological Association Education and Research, 2005; Munarriz et al., Glenn’s urologic surgery. Philadelphia, PA: Lippincott Williams & Wilkins, 2004; Lewis and Munarriz, Campbell-Walsh urology, Philadelphia, PA: Saunders Elsevier, 2007; Sharaby et al., Urol Clin North Am 22(4):821–32, 1995). Extrapolating this further, penile microvascular surgery is relevant in the armamentarium of techniques for penile replantation and reconstruction. In this chapter, we elucidate microsurgical techniques as applied to the continuum of genital disorders requiring penile revascularization, replantation, and reconstruction.