Glans Resurfacing (Glans Skinning)
Glans resurfacing (glans skinning) is an organ-sparing technique that excises the glans epithelium and subepithelium while preserving the underlying corpus spongiosum, followed by reconstruction with a split-thickness skin graft (STSG). It is a treatment of choice for selected superficial penile lesions, providing excellent oncologic control, complete histopathologic staging, and superior functional outcomes versus glansectomy and partial penectomy.[1][2][3]
For total glansectomy and neoglans reconstruction (invasive distal-glans disease) and broader oncology framework, see Penile Reconstruction. For the cross-cutting skin-graft technique itself, see Penile Skin Grafting. For tissue substitutes (dermal templates, NPWT), see Penile Grafting With Tissue Substitutes.
Indications
Superficial, non-invasive, or minimally invasive lesions confined to the glans epithelium:
- Penile intraepithelial neoplasia (PeIN) — including erythroplasia of Queyrat and Bowen disease[4][3][5]
- Carcinoma in situ (CIS / Tis) — particularly after topical (5-FU / imiquimod) or laser failure[3][5]
- Superficial squamous cell carcinoma (Ta, T1a) — confined to the glans without deep invasion[4][6]
- Refractory lichen sclerosus — intractable symptoms (pain, pruritus, phimosis) unresponsive to medical therapy[7][2]
- Refractory Zoon's balanitis[1]
Guideline endorsement:
- NCCN — may be considered in highly selected patients as part of organ-sparing for PeIN, Ta, and T1[6]
- EAU-ASCO 2023 — strong recommendation to offer organ-sparing surgery (including resurfacing) for lesions confined to the glans and prepuce (PeIN, Ta, T1–T2) in patients willing to comply with strict follow-up[4]
Key staging advantage over ablation / topical therapy: resection yields complete histopathologic staging — detecting occult invasive disease in up to 20% of patients presumed to have PeIN.[4]
Variants
| Variant | Indication | Notes |
|---|---|---|
| Total Glans Resurfacing (TGR) | Diffuse / multifocal disease across the glans | Full circumferential excision[2][5] |
| Partial Glans Resurfacing (PGR) | Localized lesion | Resection with macroscopic clear margin (≥ 5 mm)[3] |
| Coronal-Sparing Glans Resurfacing (CSGR) | Disease spares the corona | Preserves the densely innervated coronal ridge / sulcus → better erogenous sensation[7] |
Surgical Technique
Performed under general or regional anesthesia with a penile tourniquet for hemostasis.[8][5]
1. Circumcision and exposure
- If uncircumcised, circumcise first
- Incise the inner prepuce at the subcoronal level to expose the glans
2. Marking and incision
- TGR — circumferential incision at the coronal sulcus
- PGR — macroscopic margin of clinically normal tissue around the lesion (≥ 5 mm)
3. Epithelial / subepithelial excision
- Excise glans epithelium + subepithelium down to the corpus spongiosum of the glans and Buck's fascia at the coronal sulcus
- Plane superficial to the spongiosum — preserves glans architecture, vascular pedicle, and neural supply
4. Meatal management
- Carefully excise the epithelium around the urethral meatus
- Avoid meatal stenosis by minimizing thermal damage and excessive epithelial resection near the meatus
5. Hemostasis
- Release the tourniquet
- Meticulous bipolar cautery hemostasis before graft application
6. Frozen section (when margins uncertain)
- EAU-ASCO 2023 weak recommendation — not routine, but helpful when margins are in doubt[4]
- Yunis SR: mean accuracy 95.4%, sensitivity 71.4%, specificity 99.9%[9]
7. STSG harvest
- Anterolateral thigh donor, 0.046 cm (0.012–0.018 inch) depth
- Trim to size; fenestrate to allow drainage of blood and seroma[1][10][11]
8. Graft application
- Apply over the denuded glans starting ventrally and wrapping circumferentially
- Secure with absorbable suture
- The fenestrated STSG drapes naturally around the spongiosum-preserving glans contour
9. Dressing and fixation
| Technique | Description | Advantage |
|---|---|---|
| Quilting | Graft quilted directly to the glans with multiple interrupted sutures | Direct fixation; up to 5 days bed rest required[8] |
| TODGA (Tie-Over Dressing for Graft Application) | Proflavine-soaked bolster tied over the graft with sutures × 10 d | Immediate mobilization; mean LOS ~ 2 d; largely replaces quilting[8] |
10. Catheterization
- Urethral catheter 5–10 days to prevent urinary contamination of the graft[12]
11. Postoperative care
- After bolster removal, saline washing ~ 2 weeks
- Follow-up every 3 months × 2 years, then every 6 months
Graft Material — Oral Mucosa (OMG) Alternative to STSG / FTSG
The standard graft material for glans resurfacing is STSG (covered in Step 7 above). Oral (buccal) mucosa graft (OMG) is an emerging alternative that more closely mimics native glans epithelium, with distinct biological properties — rapid re-epithelialization, "scarless" healing, minimal contracture, and a moist mucosal surface.[A1][A2][A3]
Why oral mucosa for the glans?
The native glans is covered by modified mucosal epithelium (non- or minimally keratinized). STSG resurfacing produces a keratinized dry surface that diverges from native texture. BMG histologically resembles native glans epithelium and offers:[A1][A4]
- Rapid re-epithelialization — fetal-like wound-healing phenotypes with distinct fibroblast subpopulations
- "Scarless" healing — tightly controlled fibroblast action, minimal scar
- Minimal inflammation — reduces graft fibrosis / shrinkage
- Resistance to contracture — thick well-vascularized lamina propria
- Wet-environment tolerance — naturally adapted to moist surfaces
- Non-hair-bearing — never requires depilation
Penile-specific OMG glans-resurfacing indications
- Severe post-circumcision penile injuries (Grade III–V) — largest published series[A3]
- Glans reconstruction after penile-cancer surgery as an alternative to STSG[A2]
- Refractory lichen sclerosus — BMG appears resistant to LS recurrence vs keratinized skin grafts[A26][A5][A6]
- Recurrent penile adhesions — "buccal belt" subcoronal resurfacing[A7]
- Distal urethral strictures with fossa navicularis involvement — dorsal onlay BMG urethroplasty with glans preservation[A8]
- Complex hypospadias repair — BMG for glanular and urethral reconstruction[A9]
Technique variants
A. Fenestrated OMG for glans resurfacing after circumcision injury (Albaghdady / Alansari)[A3]
Largest dedicated OMG-for-glans-resurfacing series (37 pediatric patients):
- Release of subcutaneous corporal remnant
- Shaft coverage with FTSG from a non-hair-bearing donor
- Fenestrated OMG applied to the denuded glans
- Fenestration allows drainage of blood / seroma to improve take
- Quilting sutures + bolster
| Outcome | Result |
|---|---|
| Uneventful graft incorporation | 78.4% (29 / 37) |
| Urethral patency at 6 mo | 100% |
| Satisfactory cosmesis at 6 mo | 100% |
| Donor-site morbidity | 0% |
| BMG eschar | 5.4% (2 / 37) |
| Mean OR time | 150 min |
B. BMG for glans reconstruction — multi-indication (Pandey)[A2]
n = 6 across various urologic reconstructions including glans; excellent cosmetic and functional results without meatal stenosis at 26–50 months.
C. "Buccal belt" subcoronal BMG resurfacing for recurrent adhesions (Beamer multi-institutional)[A7]
n = 31 across 6 institutions, mean follow-up 27 mo:
| Outcome | Result |
|---|---|
| Resolution of symptoms | 100% |
| Adhesion recurrence | 0% |
| Mean VAS aesthetics | 8.9 / 10 |
| Mean VAS functional | 9.0 / 10 |
| GRA overall improvement | 100% |
| Mean OR time | 59 min |
D. Dorsal onlay BMG with glans preservation (Favre, distal strictures involving fossa navicularis)[A8]
n = 16, median follow-up 41.5 mo:
- 100% stricture-free at median 41.5 mo
- Median peak flow at 1 y 18 mL/s
- No erectile-function change
- HOSE ≥ 14 cosmetic score 87.5%
- Clavien-Dindo I–II 18.8%
Donor site — buccal mucosa harvest
- Inner cheek (preferred); lip or tongue alternative[A11][A12]
- Standard ovoid graft ~ 4 × 2.5 cm; avoid bilateral harvest when possible
- Stensen's duct (parotid orifice) identified and protected
- Closure: leaving the donor site open results in less postoperative pain (Wood RCT: mean 2.26 vs 3.68, p significant)[A13]
- Barbagli single-cheek closed-harvest series (n = 350) — 98% patient satisfaction[A12]
Donor-site morbidity (Barbagli 2014 multivariable, n = 553)[A11]
| Complication | Barbagli 2010 (n = 350) | Barbagli 2014 (n = 553) | Wood 2004 (n = 57) |
|---|---|---|---|
| Bleeding | 4.3% | 3.4% | — |
| Pain (moderate / severe) | 14.8% | — | 83% (any) |
| Perioral numbness (early) | 73.4% (1 wk) | — | 68% |
| Perioral numbness (persistent > 6 mo) | 3.8% | — | 26% |
| Difficulty opening mouth (persistent) | 1.7% | — | 9% |
| Dry mouth (moderate / severe) | 4.2% | — | — |
| Patient satisfaction | 98% | 98.2% | — |
| Dissatisfaction predictor | — | Bilateral harvest (OR 2.72, p = 0.02) | — |
Pediatric long-term follow-up (Castagnetti n = 78, median 7.6 y): perioral sensory defect 28% on formal oral-surgery examination, seldom perceived by patients and never required treatment.[A16]
Histologic adaptation after transplantation to the glans[A9]
- Epithelial hyperplasia with mild focal keratinization (less than STSG)
- Slight edematous lamina propria with minimal mononuclear infiltrate
- Elongated lamina propria papillae (~ 75% of mucosal thickness)
- Good vascularization maintained
- Graft remains well-vascularized and pliable at 6 mo
Tobacco use increases pre-harvest keratinization but did not produce significant vascular damage, cytologic atypia, or architectural complexity in 25-graft histologic analysis — systemic exposure causing local ischemia is the more relevant outcome modifier than the graft itself.[A17]
OMG vs STSG — quick comparison
| Parameter | Oral mucosa graft (BMG) | Split-thickness skin graft (STSG) |
|---|---|---|
| Tissue type | Non-keratinized mucosa (becomes mildly keratinized) | Keratinized skin |
| Similarity to native glans | High | Moderate |
| Contracture risk | Low (thick lamina propria) | Moderate (STSG can contract 30–50%) |
| Healing | "Scarless" fetal-like | Standard wound healing |
| Donor site | Inner cheek | Anterolateral thigh |
| Donor-site morbidity | Perioral numbness ~ 73% early / 3.8% persistent; 98% satisfaction | Thigh wound; minimal long-term morbidity |
| Graft size limit | ~ 4 × 2.5 cm per cheek; bilateral harvest worsens satisfaction | Larger grafts available |
| Evidence base for glans resurfacing | Emerging (largest n = 37 pediatric) | Extensive (n ≥ 327 in SR) |
| Meatal stenosis | Low (resists contracture) | 0–14.3% |
| Guideline endorsement | Not specifically mentioned | NCCN / EAU-ASCO supported |
LS-specific rationale
LS is thought to be exacerbated by chronic urine exposure and Koebner phenomenon in keratinized skin; oral mucosa appears more resistant to these triggers.[A6]
- Garaffa LS glans resurfacing with skin graft (n = 31): 84% satisfaction, 71% resumption of sexual activity at median 12.8 mo[A5]
- Kulkarni multicenter LS urethroplasty with oral mucosal graft (n = 215): 100% one-stage success, 73% two-stage success at mean 56 mo[A26]
- Cakir CSGR (3 / 13 refractory LS): complete graft take, preserved erogenous sensation, median IIEF-5 of 20[A27]
Emerging directions
Sterling 2026 narrative review highlights[A1]:
- Tissue-engineered oral mucosal substitutes — lab-grown alternative overcoming bilateral-harvest size constraints
- BMG-derived extracellular vesicles — scarless-healing benefit without full graft
- Organoid systems — 3D oral-mucosa generation at scale
All remain preclinical.
Limitations of OMG for glans resurfacing
- Limited evidence base — emerging vs the extensive STSG literature; no large oncologic series
- Graft-size constraints — bilateral harvest predicts dissatisfaction (OR 2.72)
- No specific guideline endorsement — NCCN / EAU-ASCO do not mandate graft type
- No published oncologic outcomes (local recurrence, CSS) when OMG used for cancer-related glans resurfacing
- Long-term keratinization implications for sensitivity and function incompletely characterized
See Buccal Mucosa Graft (foundations) for the cross-cutting technique detail.
Oncologic Outcomes
| Study | n | Indication | Procedure | Median follow-up | Local recurrence | Positive margins | CSS |
|---|---|---|---|---|---|---|---|
| Hadway 2006[5] | 10 | Premalignant (CIS) | TGR + STSG | 30 mo | 0% | 0% | 100% |
| Shabbir 2011[3] | 25 | CIS | TGR 10 / PGR 15 | 29 mo | 4% | 48% (only 28% needed re-surgery) | 100% (no progression) |
| Preto 2021[2] | 37 | LS 16, PC 21 | TGR | 22 mo | n/r | n/r | n/r |
| Cakir 2022[7] | 13 | SCC 8, LS 3, PeIN 2 | CSGR | 29 mo | 15.4% (2 / 13) | 0% | 100% |
| Elst 2025[13] | 550 | PSCC (all GSS) | GSS incl. resurfacing | 41 mo | 29% | — | 5-yr CSS 99% |
Key oncologic findings
- Local recurrence 0–15% — comparable to or lower than laser (7–48%) and topical therapy (11–20%)[4][7][14]
- Elst 2025 multicenter (n = 550): despite 29% local recurrence, 5-year CSS remained 99% — local recurrence did not impact cancer-specific mortality
- 48% positive margins in CIS, but only 28% required further surgery — additional resection did not compromise oncologic outcomes
- Up to 20% of presumed PeIN harbors occult invasive disease on final pathology — underscores the staging advantage of resection over ablation
Functional and Patient-Reported Outcomes
Preto 2021 (n = 37, TGR)[2]
- Glans sensitivity fully maintained 89.2%
- No significant deterioration in IIEF or IPSS after surgery
- 94.5% full satisfaction with aesthetic appearance
- 91.9% would recommend the procedure
- 86.4% reported overall QoL improvement
Comparative TGR vs WLE vs glansectomy (Falcone, n = 99)[15]
| Procedure | IIEF-15 change (0–12 mo) | Significance |
|---|---|---|
| TGR | − 3.1 (−5.97%) | p = 1.0 (not significant) |
| WLE | − 14.1 (− 22.9%) | p = 0.025 |
| Glansectomy | − 13.0 (− 24.1%) | p = 0.002 |
TGR provides superior sexual-function preservation vs the other two approaches.
Coronal-sparing optimization (Cakir CSGR)[7]
- Median postoperative IIEF-5 of 20 (17–23) — mild ED at most
- Preserves the densely innervated coronal ridge for erogenous sensation
Complications
Remarkably low complication profile across all major series:
- Hadway n = 10: no postoperative complications; 100% graft take[5]
- Shabbir n = 25: 96% complete graft take, no postoperative complications[3]
- Cakir CSGR n = 13: no surgical complications; complete graft take[7]
- Malone TODGA n = 29: only 1 / 29 (3.4%) re-grafting; meatal stenosis essentially absent[8]
| Complication | Rate | Management |
|---|---|---|
| Partial graft loss | < 5% in resurfacing-only; up to 17.6% in glansectomy series[16] | Local care, secondary intention |
| Meatal stenosis | 0–5.8%[16][8] | Dilation; rarely formal meatoplasty |
| Wound infection | ~ 5.8%[16] | Antibiotics |
Advantages vs Alternative Approaches
| Comparator | Glans-resurfacing advantage |
|---|---|
| Topical therapy (5-FU, imiquimod) | Histopathologic staging (detects 20% occult invasion); recurrence 0–15% vs 11–20% |
| Laser ablation | Provides tissue for pathology (laser destroys it); recurrence 0–15% vs 7–48% |
| Glansectomy + neoglans | Preserves glans architecture and corpus spongiosum → IIEF decline only − 6% vs − 24% with glansectomy[15]; glansectomy still required for deeper invasion |
| Partial penectomy | Avoids penile shortening and the psychological impact of amputation while maintaining equivalent CSS for appropriately staged disease |
Surveillance
Given the manageable risk of local recurrence (salvage-amenable without compromising survival), strict follow-up is essential:[4][7][3]
- Clinical examination every 3 months × 2 years, then every 6 months thereafter
- Patient self-examination education
- Biopsy of any suspicious lesion at follow-up
- Salvage organ-sparing surgery can be offered for small recurrences not involving the corpora cavernosa
Key Takeaways
- First-line for PeIN, Ta, T1a, refractory LS, and refractory Zoon's balanitis confined to the glans epithelium
- Three variants (TGR / PGR / CSGR) cover the spectrum of disease distribution; CSGR optimizes erogenous sensation
- Provides complete histopathologic staging — detecting 20% occult invasive disease that topical / laser approaches would miss
- Sensitivity preserved in ~ 89%; IIEF essentially unchanged — substantially better than glansectomy (− 24%) or WLE (− 23%)
- Local recurrence 0–15% with 5-year CSS 99% in the largest multicenter cohort — local recurrence is salvage-amenable and does not affect CSS
- TODGA bolster has largely replaced quilting — equivalent take, immediate mobilization, ~ 2-day LOS
Cross-references
- Penile Reconstruction — full decision framework
- Penile Skin Grafting — STSG / FTSG technique detail
- Penile Grafting With Tissue Substitutes — dermal templates and adjuncts
- Penile Primary Closure ± Z-plasty
- Foundations — Plastic Surgery Principles
References
1. Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G. "Resurfacing and Reconstruction of the Glans Penis." Eur Urol. 2007;52(3):893–8. doi:10.1016/j.eururo.2007.01.047
2. Preto M, Falcone M, Blecher G, et al. "Functional and Patient Reported Outcomes Following Total Glans Resurfacing." J Sex Med. 2021;18(6):1099–1103. doi:10.1016/j.jsxm.2021.02.012
3. Shabbir M, Muneer A, Kalsi J, et al. "Glans Resurfacing for the Treatment of Carcinoma in Situ of the Penis: Surgical Technique and Outcomes." Eur Urol. 2011;59(1):142–7. doi:10.1016/j.eururo.2010.09.039
4. Brouwer OR, Albersen M, Parnham A, et al. "European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update." Eur Urol. 2023;83(6):548–560. doi:10.1016/j.eururo.2023.02.027
5. Hadway P, Corbishley CM, Watkin NA. "Total Glans Resurfacing for Premalignant Lesions of the Penis: Initial Outcome Data." BJU Int. 2006;98(3):532–6. doi:10.1111/j.1464-410X.2006.06368.x
6. National Comprehensive Cancer Network. Penile Cancer. Updated 2025-11-12.
7. Cakir OO, Schifano N, Venturino L, et al. "Surgical Technique and Outcomes Following Coronal-Sparing Glans Resurfacing for Benign and Malignant Penile Lesions." Int J Impot Res. 2022;34(5):495–500. doi:10.1038/s41443-021-00452-5
8. Malone PR, Thomas JS, Blick C. "A Tie-Over Dressing for Graft Application in Distal Penectomy and Glans Resurfacing: The TODGA Technique." BJU Int. 2011;107(5):836–840. doi:10.1111/j.1464-410X.2010.09576.x
9. Yunis MZ, Pang KH, Muneer A, Alnajjar HM. "Intraoperative Frozen Section Examination for Penile Cancer Surgery: A Systematic Review." Int J Impot Res. 2025;37(9):721–727. doi:10.1038/s41443-025-01024-7
10. Hamad J, McCormick BJ, Sayed CJ, et al. "Multidisciplinary Update on Genital Hidradenitis Suppurativa: A Review." JAMA Surg. 2020;155(10):970–977. doi:10.1001/jamasurg.2020.2611
11. Pappas A, Katafigiotis I, Waterloos M, Spinoit AF, Ploumidis A. "Glans Resurfacing with Skin Graft for Penile Cancer: A Step-by-Step Video Presentation of the Technique and Review of the Literature." Biomed Res Int. 2019;2019:5219048. doi:10.1155/2019/5219048
12. Falcone M, Oderda M, Calleris G, Peretti F, Gontero P. "Surgical Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Localized Penile Cancer." Urology. 2021;152:195. doi:10.1016/j.urology.2021.03.022
13. Elst L, Roussel E, Miletic M, et al. "Local Recurrence After Glans-Sparing Surgery: No Impact on Penile Cancer-Specific Survival." BJU Int. 2025. doi:10.1111/bju.70055
14. Kristinsson S, Johnson M, Ralph D. "Review of Penile Reconstructive Techniques." Int J Impot Res. 2021;33(3):243–250. doi:10.1038/s41443-020-0246-4
15. Falcone M, Preto M, Gül M, et al. "Functional Outcomes of Organ Sparing Surgery for Penile Cancer Confined to Glans and Premalignant Lesions." Int J Impot Res. 2024. doi:10.1038/s41443-024-00967-7
16. Falcone M, Preto M, Blecher G, et al. "The Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Invasive Penile Cancer Confined to Glans." Urology. 2022;165:250–255. doi:10.1016/j.urology.2022.01.010
Oral Mucosa Graft (OMG) Section References
A1. Sterling J, Hecksher D, Hayden C, et al. "Buccal Mucosa a Narrative Review: How Does It Work, How Is It Used, What Is Coming Next." Urology. 2026. doi:10.1016/j.urology.2026.03.015
A2. Pandey A, Dican R, Beier J, Keller H. "Buccal Mucosal Graft in Reconstructive Urology: Uses Beyond Urethral Stricture." Int J Urol. 2014;21(7):732–4. doi:10.1111/iju.12403
A3. Albaghdady A, Alansari AN. "Reconstruction of High-Grade Post-Circumcision Penile Injuries Using Fenestrated Skin and Oral Mucosa Grafts for Glans Resurfacing: A Single-Center Experience." Pediatr Surg Int. 2026;42(1):146. doi:10.1007/s00383-026-06350-5
A4. Gn M, Sterling J, Sinkin J, Cancian M, Elsamra S. "The Expanding Use of Buccal Mucosal Grafts in Urologic Surgery." Urology. 2021;156:e58–e65. doi:10.1016/j.urology.2021.05.039
A5. Garaffa G, Shabbir M, Christopher N, Minhas S, Ralph DJ. "The Surgical Management of Lichen Sclerosus of the Glans Penis: Our Experience and Review of the Literature." J Sex Med. 2011;8(4):1246–53. doi:10.1111/j.1743-6109.2010.02165.x
A6. Kwok R, Shah TT, Minhas S. "Recent Advances in Understanding and Managing Lichen Sclerosus." F1000Res. 2020;9:F1000 Faculty Rev-369. doi:10.12688/f1000research.21529.1
A7. Beamer MR, Angulo JC, Capiel L, et al. "A Buccal Mucosal Graft Subcoronal Resurfacing Technique to Treat Recurrent Penile Adhesions: The Buccal Belt." BJU Int. 2022;129(3):406–408. doi:10.1111/bju.15670
A8. Favre GA, Villa SG, Scherñuk J, Tobia IP, Giudice CR. "Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach." Urology. 2021;152:148–152. doi:10.1016/j.urology.2020.12.014
A9. Mokhless IA, Kader MA, Fahmy N, Youssef M. "The Multistage Use of Buccal Mucosa Grafts for Complex Hypospadias: Histological Changes." J Urol. 2007;177(4):1496–9. doi:10.1016/j.juro.2006.11.079
A11. Barbagli G, Fossati N, Sansalone S, et al. "Prediction of Early and Late Complications After Oral Mucosal Graft Harvesting: Multivariable Analysis From a Cohort of 553 Consecutive Patients." J Urol. 2014;191(3):688–93. doi:10.1016/j.juro.2013.09.006
A12. Barbagli G, Vallasciani S, Romano G, et al. "Morbidity of Oral Mucosa Graft Harvesting From a Single Cheek." Eur Urol. 2010;58(1):33–41. doi:10.1016/j.eururo.2010.01.012
A13. Wood DN, Allen SE, Andrich DE, Greenwell TJ, Mundy AR. "The Morbidity of Buccal Mucosal Graft Harvest for Urethroplasty and the Effect of Nonclosure of the Graft Harvest Site on Postoperative Pain." J Urol. 2004;172(2):580–3. doi:10.1097/01.ju.0000132846.01144.9f
A16. Castagnetti M, Ghirardo V, Capizzi A, Andretta M, Rigamonti W. "Donor Site Outcome After Oral Mucosa Harvest for Urethroplasty in Children and Adults." J Urol. 2008;180(6):2624–8. doi:10.1016/j.juro.2008.08.053
A17. MacDonald SM, Decter RM, DeGraff DJ, Raman JD, Warrick JI. "Histologic Analysis of Buccal Graft Quality Stratified by Tobacco Use in Patients Undergoing Substitution Urethroplasty." Urology. 2023;172:203–209. doi:10.1016/j.urology.2022.08.068
A26. Kulkarni S, Barbagli G, Kirpekar D, Mirri F, Lazzeri M. "Lichen Sclerosus of the Male Genitalia and Urethra: Surgical Options and Results in a Multicenter International Experience With 215 Patients." Eur Urol. 2009;55(4):945–54. doi:10.1016/j.eururo.2008.07.046
A27. Cakir OO, Schifano N, Venturino L, et al. "Surgical Technique and Outcomes Following Coronal-Sparing Glans Resurfacing for Benign and Malignant Penile Lesions." Int J Impot Res. 2022;34(5):495–500. doi:10.1038/s41443-021-00452-5