ČESKÁ UROLOGIE / CZECH UROLOGY – 1 / 2021

64 KAZUISTIKY Ces Urol 2021; 25(1): 62–68 specimen was 4×3×2.3 cm. In February 2020 we performed a new biopsy of the neo‑glans/neo­ ‑meatal region due to a newly formed erythematous lesion 2 × 4 mm (recurrence of SCC was confirmed) (Fig. 2 A, B). Further diagnostic steps using flexible cystoscopy showed otherwise normal urethra and the CT scan was negative. In the meantime the patient underwent two HPV vaccinations, the last one was planned for June 2020. Because of the co‑ vid pandemic the surgery was postponed 7 weeks thereafter (in April 2020). According to the patien‑ t’s wishes and careful examination of the penile/ scrotal anatomy, we decided to perfom another organ sparing procedure. A partial penectomy (29×27×10mm/neo‑glans and; 8×5×3mm/urethral tissue) with neo‑glans reconstruction and coverage of the corpora cavernosa with urethral flap was achieved (Fig. 2). The neo‑glans was reconstructed while using the same principles as described by Palminteri et al. previously (3) (Fig. 2F, G, H, I, J). In addition the technique of scrotoplasty followed the concept initially described by Miranda‑Sousa et al. (4, 5) (Fig. 2C) The pathology revealed HPV associated PeIN and focal finding of SCC pT1NxL0V1G2R0 in the neo‑glans region and PeIN in the urethra, however R0. 10 days later (3 days after the patient’s discharge from the hospital) after the definitive procedure the patient suffered from asuperficial penile shaft tissu‑ es infection. Despite local and targeted antibiotic treatment, the patient developed ABP (Fig. 2K, L). Fig. 1. A) Total glansectomy and removal of the glandular part of the urethra for biopsy proven squamous cell carci- noma, tips of the corpora cavernosa were left intact (frozen section confirmed negative margins). B) Neo‑glans recon- struction with inverted Vicril 4.0 running suture, creating the fish‑mouth shape. C) Reconfigurationof the neo‑sulcus and placingevertingsutures for theurethrausingCaprosin4.0and 5.0 sutures respectively. D) Split thickness skingraft implanta- tion. E) 7 th postoperative day, local application of Vaseline/ Baneocintwotimesdaily, permanent catheterwas removed. F) 2weeksafterprocedure, thesuccessful graft takeandcom- pleteepithelialisationof thegraft. Someof theresidualguilting sutures are not completely absorbed. G) 1 month after the surgery, natural and satisfactory cosmetic result Obr. 1. A) Kompletná amputácia – glans penis a od- stránenie glandulárnej časti močovej trubice pre biopticky verifikovaný skvamocelulárny karcinóm. Distálne konce kavernóznychteliesboli ponechané (perioperačnáhistológia potvrdila negatívne okraje). B) Rekonštrukcia „neo‑glansu“ s invertovaným pokračovacím stehom Vicril 4,0 ; ktorý vy- tvára tvar rybých úst. C) Rekonfigurácia tzv. „neo‑sulkusu“ a následné naloženie evertovaných stehov na močovú trubicu s použitím Caprosin 4,0 ; 5,0 D) Implantácia der- moepidermálneho kožného štepu. E) 7. pooperačný deň, lokálnaaplikáciavazelíny/baneocínu2 × denne, odstránenie permanentnéhomočovéhokatétra. F) 2 týždnepozákroku, úspešnéprimárnezhojenieakompletnáepitelializáciaštepu. Niektoré z reziduálnych tzv. ukotvovacích stehovnie súešte zrezorbované. G)Mesiacpooperácii, bol dosiahnutýprirod- zene pôsobiaci a zároveň uspokojivý kozmetický výsledok C