Back to the future: The Cecil-Culp technique for salvage penile reconstructive procedures

Area of Science:

• Urology
• Reconstructive Surgery
• Pediatric Surgery

Background:

• Re-operative penile reconstruction presents challenges in achieving tension-free skin closure.
• The Cecil-Culp (CC) technique, utilizing scrotal tissue for penile reconstruction, declined due to single-stage repair trends and concerns about hair-bearing skin.
• Ventral skin deficiency and poor vascular support complicate penile reconstructive surgery.

Purpose of the Study:

• To evaluate the efficacy of a modified Cecil-Culp (CC) penile scrotalization technique.
• Hypothesized that prolonged penile attachment to the scrotum (1 year) improves outcomes for ventral skin deficiency or poor vascular support.

Main Methods:

• Retrospective review of Institutional Review Board-approved registries (1987-2016) at two institutions.
• Identified patients undergoing CC repair for complex hypospadias complications or insufficient penile shaft skin coverage.
• Recorded anatomical abnormalities, prior surgeries, and pre- and post-CC complications.

Main Results:

• Thirty-nine patients underwent CC repair for various conditions including failed hypospadias repairs, penile curvature, and skin loss.
• Perioperative complications occurred in 10.3% of patients; longer-term complications related to hypospadias repair in 21.6%.
• Mean CC attachment duration was 345-473 days; no scrotal skin transfer to the penile shaft was observed.

Conclusions:

• Modified CC repair with delayed take-down (9-12 months) enhances wound healing and prevents hair-bearing scrotal skin transfer.
• The CC technique remains a valuable option for complex hypospadias repairs with inadequate skin and traumatic penile injuries.