Definition & Overview

The scrotum is a thin sac found at the base of the penis and is an important part of the male reproductive system. It provides protection to the testes, where the sperm is produced. It also controls the temperature within the testes, providing an optimal condition for sperm production and growth.

Scrotoplasty is the surgical procedure for forming a scrotum for females who wish to undergo complete gender reassignment. It is also the term used for the surgical repair of defective or damaged scrotum. However, there are also instances when scrotum reconstruction is done for cosmetic purposes, to achieve improved appearance, and avoid sagging caused by the presence of excess skin.

Who Should Undergo & Expected Results

Scrotoplasty is recommended for:

  • Women who are undergoing gender reassignment procedure - Scrotoplasty is one of the procedures performed for women who wish to complete their transformation into the opposite gender. It is typically performed after the patient has undergone a psychological evaluation and hormonal therapy. In some instances, it is done along with other related procedures such as penis creation.

  • Males who suffer from decreased penile length. This condition is the result when too much skin is removed during circumcision leading to the attachment of scrotal skin high up on the shaft.

  • Men who wish to remove loose scrotal skin as a result of aging - More than the aesthetic concern, loose scrotal skin also causes irritation and discomfort especially when wearing tight clothes. Individuals who don’t have any underlying physiological problems but just wish to improve the appearance of their genitals may also opt for scrotoplasty.

  • Male infants born with a condition called congenital penoscrotal webbing – The condition is otherwise known as concealed or buried penis. Scrotoplasty is one of the surgical procedures used for the treatment of this condition.

  • Males who suffered a significant injury to the scrotum or diagnosed with scrotal tumours.
    As for the expected results, scrotoplasty has excellent outcomes, with short recovery time and mild associated pain. Most patients report satisfaction in both function and appearance of the affected part after surgery.

How Does the Procedure Work

This procedure is typically performed in an outpatient setting, requiring local anaesthesia. During surgery for gender reassignment, incisions are made just above the pubic bone and in the lower part of the labia majora. The lower ends are then turned up and stitched to form a pouch. After a certain amount of time, the patient undergoes another procedure to insert testicular implants into the newly-formed pouch to give it a more masculine appearance. The incision is then sutured shut.

Another scrotum reconstruction technique is used for the treatment of congenital penoscrotal webbing. One incision is made to separate the penis from the scrotum and another to remove excess tissue in the area. Sutures are then used to close the incisions.

During plastic surgery to remove sagging scrotal skin, excision is made along the median raphe between the two halves of the scrotal sacs. Once the excess tissue is removed, the excision site is closed with the use of sutures.

Possible Complications and Risks

Scrotoplasty is associated with the following risks and complications:

  • Perioperative and postoperative bleeding
  • An adverse reaction to the local anaesthesia used
  • Infection to the surgery site
  • Bruising within or around the surgery site
  • Altered or reduced sensation to the scrotum
  • Scarring that may require further surgical procedure to correct
  • Rejection or expulsion of the foreign body for those who received testicular implants
  • Pain, which may become chronic and impact the patient’s overall quality of life
    Scrotum reconstruction yields permanent results, and there may be a few patients who may not be satisfied with the aesthetic or functional outcomes.

    References:

  • Hoar RM, Calvano CJ, Reddy PP, Bauer SB, Mandell J Unilateral suprainguinal ectopic scrotum: the role of the gubernaculum in the formation of an ectopic scrotum. Teratology 1998;57:64–9.

  • Elder JS, Jeffs RD Suprainguinal ectopic scrotum and associated anomalies. J Urol 1982;127:336–8

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