Letters to the Editor 249

after radical prostatectomy. BJU Int 2004;94:603– 5 Hollenbeck BK, Dunn RL, Wei JT, Sandler HM,
5. Sanda MG. Sexual health recovery after prostatec-
4 Perelman MA, Rowland DL. Retarded ejaculation. tomy, external radiation, or brachytherapy for early
World J Urol 2006;24:645–52. stage prostate cancer. Curr Urol Rep 2004;5:212–9.

Correcting Penoscrotal Web with the V-Y Advancement Technique

We read the surgical technique proposed by Alter

[1]. He adopted the double Z-plasty for correction
of penoscrotal web. In general, this method is
effective yet technically complicated.
The ultimate goal of penoscrotal web is to
remove the web entirely via increasing ventral
penile skin length. Traditionally, the simplest and
the most commonly used method to correct
penoscrotal web is to incise the web transversely
and close the wound vertically [2]. Z-plasty,
lateral para-penile incision, and other flap
methods, like preputial skin flap rotation, etc.,
have also been advocated to treat penoscrotal web
[3,4].
Our group used V-Y advancement technique to
correct penoscrotal web (Figure 1A). A V-figured
incision (with an open angle of 60° and each arm of
1 cm in length) was made at the penoscrotal junc-
tion of the patient. The triangular skin flap was
cautiously undermined and mobilized, and the
paraspongiosal arteries underneath the flap were
deliberately preserved. The skin flap was pulled
gently upwards, and the penile skin both below
and beside the incision was also undermined for
a short distance. The wound was so sutured as
to create a Y-configured suture line using 4-0
chromic catgut. About 0.6 cm of skin length gain
was achieved from the first V-Y advancement pro-
cedure. To correct the web completely, the V-Y
advancement procedure was repeated at the site,
1.5 cm below the previous suture line as shown in
Figure 1B.
The V-Y advancement technique is an ideal
method for webbed penis correction. It can be
easily designed before the operation, and the
upward advancement of the triangular flap allows
substantial skin length gain over the penile
ventrum. Because the blood supply of the triangu-
lar flap can be well preserved, postoperative flap Figure 1 (A) From the right lateral-oblique view of the
flaccid penis, a web of penile skin was found to hang from
failure or wound contracture generally does not
the mid-penile shaft to the mid-scrotal area. (B) Two V-Y
happen after the procedure. Length gain from advancement procedures were performed to correct the
each V-Y advancement procedure, when applied webbed penis completely (500 ¥ 1000 mm [78 ¥ 78 DPI]).
on the forearm skin, was suggested to be 0.4 times

J Sex Med 2008;5:248–250

250
of the length of the straight limb of the Y [5].
Theoretically, when V-Y advancement is applied
on innately loose penile and scrotal skin, more skin
length gain can be garnered. In our opinion, when
performing the V-Y advancement technique, the
optimal open angle of the V should be around 60°,
and the length of the arms should be around 1 cm.
If the open angle is too large, the skin length gain
will be restricted. On the other hand, if the open
angle is too small, the blood supply to the tip of the
triangular flap may be compromised. The length
of the arms is also crucial for a successful correc-
tion. It has to be long enough to facilitate satisfac-
tory increase of skin length, yet not too long to
crumple the triangular skin flap hindering suturing
the V-shaped arms of the Y.
When properly performed, the V-Y advance-
ment technique is a simple, safe, and effective
method to correct webbed penis.
J Sex Med 2008;5:248–250
Letters to the Editor
References
1 Alter GJ. Correction of penoscrotal web. J Sex Med
2007;4:844–7.
2 Walsh PC. Campbell’s urology. 8th edition. Philadel-
phia, PA: Saunders; 2002:2339.
3 Glanz S. Adult congenital penile deformity. Plast
Reconstr Surg 1968;41:579–80.
4 Redman JF. Technique for the correction of penos-
crotal fusion. J Urol 1985;133:432–3.
5 Cohen M. Mastery of plastic and reconstructive
surgery. 1st edition. Boston, MA: Little Brown &
Company; 1994:27–8.
Shang-Jen Chang, MD
Department of Urology, Buddhist Tzu Chi General
Hospital, Taipei Branch, Taiwan
Shih-Ping Liu, MD, and
Ju-Ton Hsieh, MD
Department of Urology, National Taiwan University
Hospital, Taipei, Taiwan