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The Methodist Center for Restorative Pelvic Medicine
6550 Fannin Street
Houston, TX 77030
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Penile reconstruction gives patients who have suffered trauma or intensive resection of the penis due to penile cancer the ability to restore the form and function of missing parts. The Methodist Hospital will not only provide excellence in innovative microsurgical techniques to reestablish blood flow and tissue growth, but also promises to uphold accountability, reassuring the patient will have a speedy recovery with minimal risks.
The goals of reconstructive pelvic surgery:
- Provide symptom relief
- Return the organs to their normal anatomic position
- Restore normal organ function
With modern techniques and new grafting materials, restorative pelvic surgery is achieving better long term success than with traditional techniques used just a few years ago.
Partial Penile Reconstruction
In partial penile reconstruction surgery, absence of penile skin can be treated with a skin graft or with rotation of scrotal skin flap to cover the wound. Partial absence of the penis can be repaired with vascularized tissue using flaps from the scrotum or adjacent perineal or groin areas. The use of microsurgery techniques will restore sensation by attaching blood vessels from borrowed tissue on the body.
Total Penile Reconstruction
In total penile reconstruction (as in the total absence of the penis), a specialized microsurgery technique is required. This technique results in a higher success rate. Tissue from the forearm (or back) can be used to reconstruct both the urethra and the penile shaft. The tissue is shaped to resemble a penis (with the urethra) and transferred to the perineum. Blood supply is reestablished using microsurgery to restore function, including erectile ability with placement of inflatable rods. Sensation is restored by reconnecting the sensory nerves of the new penis to the nerves in the pelvis.
Reconstruction of the scrotum often makes use of the remaining scrotal skin. Scrotal skin is elastic and can often be stretched to cover a large wound. Exposed testes can be temporarily "buried" underneath the skin from the thigh or the groin for protection until definitive reconstruction can be done. In the absence of scrotal skin, skin grafts can be used to cover the testes and spermatic cords. For large and complex wounds, local skin flaps from the thigh or groin can be formed to resemble scrotal sacs to support and protect the testes.
The goals of reconstructive pelvic surgery are to provide symptom relief, to return the organs to their normal anatomic position if possible, and to restore normal organ function. With modern techniques and new graft materials, restorative pelvic surgery results in much better long-term success than with traditional techniques used just a few years ago.
The initial goals of vaginal reconstruction methods include:
- The need to cover or close the wound and to separate the outside environment from the pelvic cavity
- The reconstruction of an organ which can restore a woman’s sexual function and repair of a delicate area of the body to an acceptable appearance
- Assist in the physiological and psychological recovery through sexual therapy
- Restoration of sensation
Total Vaginal Reconstruction
Methods of total vaginal reconstruction can achieve a soft and pliable vault with sufficient depth and bulk to achieve both the function reconstruction and the coverage of the wounds. The vaginal vault is reconstructed using tissue from the abdomen, specifically the vertical restus abdominis muscle and a skin flap. This borrowed skin can be taken from the back of the thighs or even the inner thighs to create the vault.
Partial Vaginal Reconstruction
The use of vascularized flaps is extremely important in the healing process for partial vaginal reconstruction. Tissue from the abdomen, thighs or bowel can be shaped and reconnected to the rest of the vagina in order to restore the vault and its function. A fistula is an abnormal tunnel connecting two body cavities. Fistula repair often requires new tissue with stable blood flow to help in wound healing. In this procedure, vascularized flaps are excellent because they thrive off the original blood flow. The interposition or coverage of a repaired fistula with a flap increases the chance of uncomplicated wound healing.
The vulva is the entire external part of the female genitalia. The vulva consists of the outer and inner lips of the vagina (labia majora and labia minor) and the urethra. The perineum is the area between the bottom of the vulva and the anus.
Conditions that may require vulvar reconstruction are:
- Carcinoma in-situ
- Cancer of the vulva
Since these conditions may cause unsightly defects in the external genitalia, methods of vulvar reconstruction provide the patient with immediate anatomical restoration. Another benefit of the procedure is proper healing at the tumor removal site.
The skinning vulvectomy done for in-situ cancer creates a wide, but superficial defect. This defect can be managed by free split-thickness skin grafts or various types of skin flaps, including the rhomboid and Z-plasty flaps. The defect following radical excision for invasive carcinoma of the vulva is more extensive and deeper than that following superficial excision and involves all layers down to the deep fascia. Resurfacing these deep defects has been a major challenge. The classical methods of coverage and reconstruction, which include split thickness skin grafting and local and/or distant skin flaps, have not been satisfactory. Muscle and musculocutaneous flaps have, however, greatly facilitated reconstruction of these very deep defects.