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Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults

Abstract

Background

Increased scrotal laxity is a poorly defined entity often associated with discomfort while wearing loose clothes, walking, doing sports and during intercourse. In our experience, this condition is produced by an enlarged scrotal bag hanging more than 1–2 cm below the tip of the penis and can be associated with persistent penoscrotal webbing. Our objective was to perform a systematic literature review addressing the diversity of this entity and its surgical treatment, as well as propose a diagnostic and therapeutic approach.

Methods

A systematic search strategy was performed following PRISMA guidelines under the terms: Scrotum(Mesh), Plastic Surgery(Mesh), Reduction Surgery, Scrotoplasty, Ventral Phalloplasty, Scrotomegaly, Penoscrotal Web, Webbed Penis(Mesh), Scrotal Lifting, Scrotopexy and Scrotal Tuck. Articles referring to scrotum reduction or plasty in male genital rejuvenation context and ventral phalloplasty related to adult penoscrotal webbing correction were considered eligible for analysis. A management algorithm and surgical technique is proposed along with the results.

Results

A total of 1430 articles were found. After removing duplicates and applying inclusion and exclusion criteria, 11 articles were eligible for analysis. Most articles corresponded to case reports or surgical technique descriptions. Based on correcting excessive scrotal skin and/or penoscrotal webbing, we propose a vertical midline scrotal skin resection and a penoscrotal junction Z plasty, respectively.

Conclusions

Aesthetic scrotoplasty and scrotal rejuvenation surgical techniques still remain as entities poorly addressed in the international literature. More reported experiences are needed in order to complement our proposed management algorithm and develop a nomenclature, diagnostic and treatment consensus.

Level of Evidence IV

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Acknowledgement

Authors would like to thank Dr. Juan Enrique Berner for his contribution revising the final version of this manuscript.

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The authors received no financial support for the research, authorship or publication of this article.

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Correspondence to Alfonso Navia.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Our preferred aesthetic scrotoplasty technique is shown in a 65-year-old healthy male consulting with objective scrotal laxity and penoscrotal webbing. (MP4 91842 kb)

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Thomas, C., Navia, A. Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults. Aesth Plast Surg 45, 769–776 (2021). https://doi.org/10.1007/s00266-020-01998-3

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Keywords

  • Aesthetic scrotoplasty
  • Scrotum reduction surgery
  • Scrotal lifting
  • Scrotomegaly
  • Scrotopexy