An improved surgical technique for penoscrotal transposition: the penile upward migration method

INTRODUCTION: Penoscrotal transposition(PST) is a congenital malformation often associated with hypospadias. Conventional techniques, such as the scrotal M-shaped flap method and buttonhole technique, are limited by significant trauma, compromised blood supply, or unsatisfactory cosmetic outcomes. The "penile upward migration method", derived from the buttonhole technique, has been used clinically since February 2018 in our center to correct PST. It is based on the therapeutic principle of the buttonhole technique. This study aims to evaluate the clinical efficacy and safety of a novel "penile upward migration method" for correcting PST. METHODS: A retrospective case series study was conducted on patients who underwent surgery using the penile upward migration method between January 2018 and June 2023. During the operation, a larger circle is marked around the penile base, while a smaller concentric circle is marked and excised to allow upward penile migration. This technique can be used for isolated PST, residual PST after hypospadias repair, or simultaneous correction of PST and hypospadias. Data on demographics, operative details, complications, and postoperative cosmetic outcomes were collected and analyzed. RESULTS: A total of 35 patients (29 with partial and 6 with complete PST) were included in the study. The mean age was 51.6 months. Thirty-two patients underwent PST correction alone (average operative time: 70.36 ± 9.76 min), while 3 patients underwent simultaneous correction with hypospadias repair (average operative time: 156.67 ± 21.86 min). Postoperative follow-up averaged 13.6 months. Complete correction was achieved in 33 cases. Complications included one case of partial skin necrosis at the penile root and two cases of hypertrophic scarring, all of which resolved with subsequent treatment. Caregivers reported high satisfaction with the postoperative penile and scrotal appearance based on the modified Pediatric Penile Perception Score (PPPS). CONCLUSION: The penile upward migration method is a safe and effective way of correcting PST. This surgical procedure is also simpler than the buttonhole method. It offers advantages of shorter operative time, minimal impact on penile blood supply, and aesthetically pleasing results with hidden scars. However, further comparative studies are warranted.