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Penoscrotal-Web Correction (Ventral Phalloplasty)

Penoscrotal-web correction releases the web of scrotal skin extending onto the ventral penile shaft and can increase visible penile length and define the penoscrotal junction; the procedure is intended to address complaints such as difficulty with condom fit or intercourse.[1][2][5] Miranda-Sousa and colleagues describe it as "simple, safe, and reproducible." It can be performed as a standalone cosmetic procedure or as an adjunct to penile-prosthesis implantation, suspensory-ligament release, or other genital aesthetic surgeries.[1][2][3]

For the broader male cosmetic-genital-surgery decision framework see the Male Cosmetic Genital Surgery atlas page. For the related but distinct skin-resection procedure see Reduction Scrotoplasty. For the foundational geometric flap principles see Z-Plasty and V-Y Advancement.

I. Definition and Anatomy of Penoscrotal Webbing​

Penoscrotal webbing (PSW), also called "webbed penis", is a condition in which scrotal skin inserts abnormally high on the ventral penile shaft, creating a web-like membrane that tethers the ventral penis to the scrotum. This obscures the ventral penile shaft, shortens the visible penile length, and blurs the normal penoscrotal angle.[4][5][6]

Normal anatomy. The penoscrotal junction is a well-defined angle where ventral penile skin meets anterior scrotal skin. Normally this junction sits at or near the base of the penile shaft, creating a clear demarcation between penis and scrotum.

Webbed anatomy. In PSW, the scrotal skin extends distally along the ventral penile shaft, sometimes reaching the mid-shaft or even the coronal sulcus in severe cases. The web consists of scrotal skin, dartos fascia, and subcutaneous tissue that are continuous with the ventral penile skin rather than forming a distinct junction.[5][6][7]

Pathophysiology. PSW can be:[4][6][7][8]

  • Congenital. Developmental abnormality of the ventral penile skin and penoscrotal junction with an uncertain embryologic mechanism[5]; may occur in isolation or with hypospadias, chordee, or phimosis. Congenital webbed penis (CWP) sits in the spectrum of "concealed penis" disorders alongside buried penis (phallus concealed in prepubic fat) and trapped penis (phallus trapped by scar tissue after circumcision).
  • Acquired. May develop after circumcision (particularly aggressive ventral skin removal), after penile surgery, or as part of age-related scrotal laxity.[4][9]
  • Iatrogenic. Excessive ventral skin removal at circumcision can create secondary webbing, whereas scar tissue after penile surgery can trap the penis; these are distinct diagnoses.[5][6][7][29]

II. Classification — El-Koutby Grading System​

The Bagnara 2024 V-I reconfiguration study graded congenital webbed penis with the El-Koutby classification.[10]

  • Grade 1. Mild; scrotal skin extends slightly onto the proximal ventral shaft.
  • Grade 2. Moderate; scrotal skin extends to the mid-shaft.
  • Grade 3. Severe; scrotal skin extends to the distal shaft or coronal sulcus.

The same classification also distinguishes compound webbing: Type 1 with prepenile scrotum, Type 2 with penile curvature and Type 3 with a broad web. Postcircumcision webbing is classified as secondary.[5]

In the Bagnara series, 52% were Grade 3, 24% Grade 2, and 24% Grade 1; most patients in this pediatric series had significant webbing.[10]

No standardized grading system exists for adult-onset or acquired PSW. Thomas & Navia 2021 propose that a "bothersome scrotum" hangs > 1–2 cm below the penile tip and may be associated with persistent webbing, but this is not a validated classification.[4]

III. Indications​

A. Cosmetic / aesthetic[1][4][5][11]​

  • Shortened visible penile length. The web obscures the ventral shaft, making the penis appear shorter than it actually is. Correction "unmasks" the ventral shaft and increases visible length without lengthening the corpora cavernosa.
  • Poor genital cosmesis. Blurred penoscrotal junction.
  • Psychological distress. Among 98 adolescents operated on for external genital conditions, webbed penis (41.8%) and penile curvature (39.8%) were the most frequent diagnoses; genital self-evaluation scores improved significantly after surgery, most in concealed and webbed penis. Overweight is associated with worse preoperative genital self-evaluation scores.[11]
  • Genital rejuvenation. Increasingly sought as part of comprehensive male aesthetic genital surgery.[4]

B. Functional[2][5][11]​

  • Difficulty with condom application: the web interferes with proper placement and retention.
  • Ventral penile curvature during erection: tethering effect of the web.
  • Difficulty with intercourse: mechanical interference.
  • Hygiene difficulties: skin folds at the penoscrotal junction trap moisture and debris.

C. Adjunctive to other procedures[2][12][13][14]​

  • Penile-prosthesis implantation. Most common context. In the Miranda-Sousa comparison with clinical records of patients who had no web release, 84% (31 of 37) complained of penile shortening after prosthesis placement, and 84% (36 of 43) of those with web release reported increased penile length; the release group included 39 inflatable and four semirigid implants.[2]
  • Suspensory-ligament release. Web correction complements SLR by addressing the ventral component of penile concealment while SLR addresses the dorsal or pubic component.[15]
  • Suprapubic lipectomy. Combined with web correction for comprehensive genital aesthetic optimization (see Suprapubic Lipectomy).[15][16]

IV. Surgical Techniques​

A. Z-plasty at the penoscrotal junction​

Thomas & Navia propose Z-plasty at the penoscrotal junction for penoscrotal webbing in their algorithm, which rests on a systematic review of 11 articles, mostly case reports and technique descriptions.[4]

Principle. Z-plasty transposes two triangular flaps to break up the linear web, redistribute tissue tension, lengthen the ventral penile skin, and reorient the central scar axis. A standard 60° Z-plasty lengthens the central limb by approximately 75% (theoretical √3 ≈ 73%; clinically reported 50–70%) and reorients the central axis by 90°.[17][24][25]

Geometry of flap angle, lengthening and reorientation:[17][24][25]

Flap angleTheoretical lengtheningReorientation of central limb
30°25%45° [25]
45°50%60° [25]
60° (standard)75%90° [25]
75°100%105°
90°120%120°

A 60° Z-plasty is the conventional design. Angles above 60° increase theoretical elongation but markedly increase flap-transposition force and make closure difficult; Roggendorf observed shortening with 30° angles in planimetric testing.[17][24][25] Keeping the two peripheral limbs identical in length and angle is needed; mismatched flaps cause dog-ears and increase the risk of tip necrosis.[17][24][25]

Stepwise operative protocol.[4][17][18][19][26]

  1. Positioning / anesthesia. Supine; local ± sedation or general.
  2. Identify the web. Place the penis on gentle stretch to define the V-shaped tethering on the ventral shaft.
  3. Design. Central limb along the line of maximal contracture (ventral midline of the web); two peripheral limbs of equal length at 60° from each end of the central limb, oriented in opposite directions: one onto ventral penile shaft, one onto scrotal skin.
  4. Incise. Full-thickness through skin and superficial dartos along all three limbs; preserve urethra and corpus spongiosum.
  5. Elevate the two triangular flaps in the subdartos plane with adequate thickness to preserve perfusion.
  6. Release tethering dartos bands to fully unmask the ventral shaft.
  7. Transpose the two flaps, which converts the vertical web into a transverse or oblique orientation, lengthening ventral skin and recreating the penoscrotal angle.
  8. Layered closure. Dartos with absorbable braided suture; skin with 4-0 or 5-0 absorbable (chromic or polyglactin rapide).
  9. Dressing. Light compression; scrotal support.

Variations.[18][26][27]

VariationDescriptionBest indication
Classic single Z-plastyStandard 60° Z at the penoscrotal junctionMild–moderate webbing
Multiple (serial) Z-plastiesSeries of smaller Z's linked along the webLonger webs needing distributed lengthening
Double-opposing Z-plastyTwo Z's in opposing directions sharing a central limbLimited adjacent tissue; provides depth
Five-flap Z-plastyModified design with five flaps for maximal lengtheningSevere contracture / webbing[27]

Outcomes: Álvarez Vega 2025 (100 Z-plasty procedures). This pediatric series covered mixed penile and scrotal indications (41 hypospadias revisions, 28 primary hypospadias repairs, 10 chordee corrections and 21 other reconstructions).[18]

  • Primary skin-flap healing in 98% of 100 mixed pediatric Z-plasty procedures.[18]
  • One case (1%) of suture-line separation, healed by secondary intention.[18]
  • One case (1%) of hypertrophic scar, managed with local steroid.[18]
  • Stable corrections with minimal visible scarring in the 97% of patients with complete follow-up.[18]
  • The authors call Z-plasty "highly effective, versatile, and safe" for pediatric genital reconstruction.

Flap perfusion. Flap necrosis or sloughing can complicate Z-plasty; maintaining adequate flap thickness and tension-free transposition are operative principles.[17][28]

B. V-Y advancement plasty​

Principle. V-shaped incision at the penoscrotal junction; flap is advanced distally and the wound is closed in a Y configuration. This effectively lowers the scrotal insertion point.[2][3]

Technique. Chang and colleagues described V-Y advancement while preserving the paraspongiosal arteries beneath the flap.[30]

  1. V-shaped incision designed at the penoscrotal junction with apex pointing toward the scrotum.
  2. V-flap elevated and advanced distally toward the penile tip.
  3. Donor site closed in a Y configuration.
  4. Advancement lengthens the ventral penile skin and lowers the scrotal attachment. In Chang and colleagues' technical report, the first V-Y gained about 0.6 cm of ventral skin; a second V-Y 1.5 cm below the first was needed to release that web completely.[30]

Concern: dehiscence risk. In Gupta 2019 (n = 103 scrotoplasty + IPP), V-Y plasty was independently associated with wound dehiscence (OR 4.9; 95% CI 1.2–8.6, p = 0.003) versus other scrotoplasty techniques.[20]

C. Ventral phalloplasty ("check mark" incision) — Caso & Carrion 2008​

Specifically described for use during penile-prosthesis implantation.[3]

  1. The penoscrotal web is defined and marked.
  2. A "check mark" incision is made: an oblique incision at the penoscrotal junction with excision of a wedge of scrotal tissue.
  3. The incision provides exposure for prosthesis cylinder, pump, and reservoir placement.
  4. In Caso and colleagues' prosthesis-associated method, close deep tissue over the device with interrupted 3-0 Monocryl, then close the skin longitudinally along the shaft, converting the oblique defect into a longitudinal closure.[3]
  5. This effectively lowers the scrotal insertion and exposes more ventral penile shaft.

The authors described this as "a modified extension of surgeries described in the pediatric literature for webbed penis" that can be performed standalone or in concert with penile-prosthesis implantation.[3]

D. V-I penoscrotal reconfiguration — Bagnara 2024​

A newer technique specifically for congenital webbed penis.[10]

  1. V-shaped incision at the penoscrotal junction.
  2. Detach the skin from dartos, slide the triangular flap toward the scrotum, and approximate the midline skin edges in an I configuration.[10]
  3. Before incision, Bagnara and colleagues temporarily approximated the inverted-V limbs at the midline to check the planned penoscrotal angle, ventral skin tension, and penile sleeve compression.[10]

Outcomes (n = 21).[10]

  • No postoperative complications were reported among 21 children at scheduled assessments through 12 months.[10]
  • No redo surgeries were reported among 21 children through the scheduled 12-month assessment.[10]
  • Parent-rated satisfaction score of 4 in 81% (17/21) and 3 in 19% (4/21).[10]
  • The authors advocate correction in childhood to prevent psychological and sexual issues.

E. Longitudinal ventral-raphe release with scrotal descent (Chen 2012)​

Chen and colleagues incised the ventral median raphe longitudinally, released adherent scrotal tissue from the spongiosum and shaft, lowered the scrotal skin, and closed the incision. They used an inverted-Y modification for a broad web.[5]

Chen 2012 (n = 12 patients, ages 14–23).[5]

  • Operation time 20 min to 1 hr.
  • Mean blood loss under 50 mL in Chen’s 12-patient series.[5]
  • All 12 patients in Chen’s series had satisfactory cosmetic results at 1–3 months.[5]
  • No severe complications; follow-up was 1 to 3 months.

F. Scrotal-raphe approach (Borsellino 2007)[6]​

  • Incision along the scrotal raphe (midline of the scrotum).
  • Penile shaft exteriorized and the penoscrotal angle reconstructed through this scrotal incision.
  • No flaps, grafts or ventral Z-plasty were used; all 11 webbed penises were phimotic and required circumcision.
  • No webbed penis recurred among 11 children (0/11); buried penis recurred in 3/56 (5.3%) and trapped penis in 2/20 (10%) after at least 1 year of follow-up.[6]
  • The authors report that the approach "simplified the complete exteriorization of the penile shaft, with easy bleeding control."

G. Concealed-penis repair with penoscrotal-angle reconstruction (Xu 2015)[19]​

For concealed penis (buried, webbed, or trapped subtypes). Pairs complete penile degloving with a longitudinal ventral incision at the penoscrotal junction (access and dead-space drainage) and tunica-albuginea-to-proximal-dartos fixation to reconstruct the penoscrotal angle and prevent retraction; the authors present the longitudinal incision and Z-plasty as interchangeable within the same framework. Xu reported 41 concealed-penis repairs using either a longitudinal incision or Z-plasty: correction succeeded in all, with a median 2.1-cm flaccid-length gain and 6-month to 2-year follow-up; the abstract gives neither incision-specific results nor a complication count.[19] See the dedicated page: Longitudinal Incision + Penoscrotal-Angle Reconstruction (Xu).

V. Outcomes — Comparative Summary​

TechniqueStudynComplication rateDehiscenceSatisfactionKey advantage
Z-plastyÁlvarez Vega 2025[18]100 mixed pediatric procedures2/100 reported minor events1/100—Stable correction in 97/97 completing 1–2-year follow-up; breaks up linear scar
Z-plasty (algorithm)Thomas & Navia 2021[4]————Proposed in a systematic review of 11 mostly case reports
V-Y plastyGupta 2019[20]103 scrotoplasties with IPP, using multiple techniques15/103 (14.6%) dehiscence across techniquesOR 4.9 for V-Y vs other techniquesNot reportedGood tissue advancement
V-I reconfigurationBagnara 2024[10]21 children0/21 reported through scheduled 12-month assessments0/21 reportedParents scored 4, the top of a 0–4 scale, in 17/21 (81%)Longitudinal midline closure; no comparative arm
Ventral phalloplasty ("check mark")Miranda-Sousa 2007[2]43 with penile prosthesis (39 inflatable, 4 semirigid)Hematoma 2/43 (4.7%); superficial dehiscence 3/43 (7.0%)3/43 (7.0%) superficial42/43 (98%) overall satisfaction; 36/43 (84%) perceived length gain at 3 monthsAdds mean 11.7 min with prosthesis placement
Longitudinal ventral-raphe releaseChen 2012[5]12No severe complicationsNot reportedSatisfactory in allScrotal tissue release; 1–3 months follow-up
Scrotal-raphe approachBorsellino 2007[6]11 webbed children within 87-child concealed-penis series0/11 reported0/11 reportedParent-rated good cosmetic results for the full 87-child series, not separately reported for webbed casesNo flaps or grafts; no recurrence in 11 webbed penises at ≥1 year

VI. Penoscrotal-Web Correction Combined With Penile Prosthesis​

Direct web-release outcome data come mainly from short-term, nonrandomized prosthesis series.[2] The two randomized prosthesis studies below tested different or bundled lengthening procedures.[14][16]

Miranda-Sousa 2007 (n = 80)[2]​

  • Forty-three patients underwent penile-prosthesis placement plus web release (39 inflatable and four semirigid devices); 37 patients without web release formed a comparison group assessed from clinical records.[2]
  • All 80 patients in the comparison had a high ventral scrotal insertion (penoscrotal web).[2]
  • With web release. At 3 months, 36/43 (84%) perceived increased penile length, 5/43 (12%) no change, and 2/43 (5%) decreased length.[2]
  • Without web release. Clinical records showed 31/37 (84%) complained of penile shortening and 1/37 (3%) reported increased length.[2]
  • 42/43 (98%) reported good overall satisfaction with the surgery at 3 months in the web-release group.[2]
  • Complications with implant plus web release: wound hematoma 2/43 (4.7%) and focal superficial dehiscence 3/43 (7.0%).[2]
  • Added operative time with implant plus web release was approximately 12 minutes (mean 11.7 min).[2]
  • Authors' verdict: "Release of penoscrotal web is a simple, safe, and reproducible procedure that can enhance patient perception of penile length and further improve satisfaction."

Abdelwahab 2025 RCT: combined maneuvers (n = 61)[14]​

The randomized comparison tested a four-component lengthening package during malleable prosthesis placement. Length and satisfaction outcomes were assessed at 3 months.

  • Group A (n = 31): malleable penile prosthesis with SLR, lower penopubic Z-plasty, and dorsal and ventral phalloplasty.[14]
  • Group B (n = 30): malleable penile prosthesis alone through a ventral midline penoscrotal incision.[14]
  • Mean functional and visible penile lengths were greater in Group A (p < 0.001), and the EDITS resting-state score was higher (55.2% vs 0.0%, p < 0.001) at 3 months.[14]

Aboul Fotouh El Gharably 2022 RCT: adjacent lengthening evidence, not web-release evidence (n = 61)[16]​

This trial tested dorsal/pubic lengthening maneuvers with malleable prosthesis placement.

  • Group A (n = 31): malleable penile prosthesis with SLR and pubic lipectomy via penopubic Z-plasty.[16]
  • Group B (n = 30): conventional malleable penile prosthesis through a penoscrotal incision.[16]
  • Visible penile-length gain: +2.5 cm (IQR 1–3.5) in Group A versus 0 cm (IQR −1 to 0) in Group B (p < 0.001).
  • Median operative time was 170 min in Group A and 97.5 min in Group B (p < 0.001).

Mokhless 2010 (n = 9 adolescents with circumcision-related traumatic distal penile amputation and prior skin advancement)[15]​

  • Z-plasty of penoscrotal web with SLR and suprapubic-fat liposuction.
  • Functional penile length increased by +18–30 mm (mean 23 ± 4 mm) in the erect state at 3 mo.[15]
  • No postoperative complications occurred.
  • All nine patients in this series had normally developed corpora cavernosa.[15]

Spyropoulos 2005 (n = 11 combined augmentation phalloplasty)[21]​

  • Penile lengthening (suprapubic skin advancement and ligamentolysis) ± dermal-fat graft ± panniculectomy or lipectomy.
  • Mean flaccid-stretched length gain +1.6 cm; mean circumference gain +2.3 cm at the base and +2.6 cm subcoronally.[21]
  • 91% of the 11 selected men reported significant (20–53%) improvement in sexual self-esteem and functioning.[21]

VII. Complications​

Reported morbidity varies by setting: Chen reported no severe complications among 12 patients at 1–3 months, and pediatric series reported 0/11 complications in webbed children, 0/21 postoperative complications after V-I repair through 12 months, and 2/100 minor events after mixed genital Z-plasties.[5][6][10][18] Miranda-Sousa reported 2/43 hematomas and 3/43 superficial dehiscences at 3 months after prosthesis plus web release; Gupta reported dehiscence in 15/103 (14.6%) initial-IPP scrotoplasties.[2][20]

ComplicationIncidenceRisk factorsManagement
Wound dehiscence15/103 (14.6%) after scrotoplasty with IPP[20]; 1/100 suture-line separation after mixed pediatric Z-plasty[18]Diabetes (OR 6.1); V-Y plasty (OR 4.9) in the IPP scrotoplasty cohort[20]Conservative (mild); suture reinforcement (moderate); OR washout (major, 1/103)
Hematoma2/43 (4.7%) with prosthesis plus web release[2]Anticoagulation; inadequate hemostasisObservation vs drainage
Superficial wound dehiscence3/43 (7.0%) with prosthesis plus web release[2]V-Y technique associated with dehiscence in a separate IPP scrotoplasty cohort[20]; tension on closureWound care; usually heals secondarily
Hypertrophic scar1/100 (1%) in mixed pediatric genital Z-plasty procedures[18]Individual scarring tendencyLocal steroid injection
Edema, glans numbness or instability after combined pubic lengtheningIn a malleable-prosthesis trial of SLR plus lipectomy via penopubic Z-plasty: 24/31 (77.4%), 3/31 (9.7%) and 3/31 (9.7%), respectively.[16]Combined pubic dissectionManage according to the specific injury and operation
Recurrence of webbing0/11 webbed children at at least one year in Borsellino.[6]Not established for adult web correctionAssess the anatomy before revision

Risk factors: Gupta 2019.[20]

  • Diabetes. Strongest predictor of wound dehiscence (OR 6.1; 95% CI 1.5–25.0; p = 0.013).[20]
  • V-Y plasty technique independently associated with dehiscence (OR 4.9; 95% CI 1.2–8.6; p = 0.003).[20]
  • Age, Peyronie's disease, hypertension, smoking, and device manufacturer were not associated.
  • Authors recommend that diabetic patients be specifically counseled about increased wound-complication risk.

VIII. Psychological Impact and Patient Selection​

Adolescent genital dissatisfaction — Zampieri 2022 (n = 98)[11]​

  • Webbed penis and penile curvature were the most frequent pathologies among adolescents operated on for external genital conditions.
  • Patients with concealed penis and webbed penis showed the best postoperative improvement in genital self-evaluation scores.
  • Overweight associated with worse preoperative scores.
  • Authors' verdict: "Cosmetic genital surgery should be considered even in male adolescents."

Adult genital self-image — Hustad 2022 (n = 3,503)[22]​

  • 33.8% of all individuals in the online survey reported dissatisfaction with genital appearance.[22]
  • 5.5% of males had severely low genital self-image (2 SD below mean).[22]
  • 11.3% of males had considered cosmetic genital surgery.[22]
  • Larger penis size predicted higher genital self-image, but avoidance or safety-seeking behaviors and openness toward surgery predicted lower self-image; psychological factors play a significant role beyond anatomy.

Long-term outcomes of concealed-penis repair — Herndon 2003[9]​

  • In Herndon’s parent telephone survey after 14 infant/toddler concealed-penis repairs (mean 41.7 months), parents reported improved appearance (100%), hygiene (87%), and accessibility (86%).[9]
  • In Herndon’s four-adolescent parent telephone-survey subgroup, 50% reported improved appearance, 50% improved hygiene, and 75% improved penile accessibility at a mean 38.8 months after surgery.[9]
  • Despite less favorable adolescent results, all four adolescent parents in Herndon’s telephone survey would still recommend the surgery to a friend with the same problem.[9]
  • Bagnara and colleagues separately advocate childhood correction to prevent psychological and sexual issues, but their retrospective 21-child series did not compare ages at surgery.[10]

IX. Standalone Cosmetic Penoscrotal-Web Correction — Practical Considerations​

Patient selection.[4][5][22]

  • Patients with visible PSW causing cosmetic dissatisfaction, functional complaints (condom difficulty, ventral curvature), or psychological distress.
  • Distinguish isolated webbing from adult-acquired buried penis, whose repair can include shaft unburying, skin reconstruction, or escutcheonectomy according to the anatomy, and from penile dysmorphic disorder, which warrants psychological assessment before cosmetic surgery and may benefit from psychological intervention.[23][32]
  • The SMSNA 2024 statement requires that penile dysmorphic disorder be ruled out before invasive treatment, using questionnaires such as the Body Dysmorphic Disorder Questionnaire or Symptom Scale together with professional psychological or psychiatric assessment.[23]
  • No standardized diagnostic criteria; clinical assessment is subjective.[4]

Preoperative counseling.[5]

  • Goals of surgery should be clearly defined: (1) expose the glans and coronal sulcus; (2) match penile-skin length dorsally and ventrally; (3) provide a normal penoscrotal junction.
  • Web correction increases visible penile length but does not increase actual corporal length.
  • Expected length gain is primarily perceptual; the ventral shaft that was previously hidden by the web becomes visible.

Anesthesia. In Chen's 12-patient series, the operative description specifies epidural anesthesia for the eight simple and two compound type 2 repairs.[5]

Operative time. 20 minutes to 1 hour for standalone web correction; adds approximately 12 minutes when combined with IPP.[2][5]

Postoperative care (typical institutional regimen).

  • Supportive underwear for 2–4 weeks.
  • Activity restriction (no sexual activity) for 4–6 weeks.
  • Wound monitoring, particularly in diabetic patients.[20]

CPT coding​

  • CPT 55180. Scrotoplasty, complicated; appropriate for penoscrotal Z-plasty given the flap-transposition component.
  • When performed concurrently with penile-prosthesis implantation, code separately from the prosthesis-placement codes.[1][3]

X. Technique Selection Algorithm​

Based on Thomas & Navia 2021 and the available evidence.[4]

Penoscrotal webbing alone (no scrotomegaly).

→ Z-plasty at the penoscrotal junction: proposed by the Thomas & Navia algorithm.[4] It breaks up the linear scar and redistributes tissue tension, and a mixed pediatric series reported 2% minor complications.[4][18]

Penoscrotal webbing + scrotomegaly.

→ Z-plasty at the penoscrotal junction plus vertical midline scrotal-skin resection: addresses both components simultaneously. See Reduction Scrotoplasty for the skin-resection deep-dive.[4]

Combined with penile prosthesis.

→ Ventral phalloplasty ("check mark" incision or V-Y plasty): provides exposure for prosthesis placement while correcting the web. In Gupta’s retrospective IPP series, V-Y plasty was associated with higher dehiscence odds (OR 4.9), and diabetes was a separate predictor (OR 6.1).[2][3][20]

→ In patients with diabetes, counsel about higher wound-dehiscence risk when adding scrotoplasty to prosthesis placement.[20]

Congenital webbed penis (pediatric / adolescent).

→ V-I penoscrotal reconfiguration was described in 21 children, with no complications or redo procedures reported through the scheduled 12-month follow-up; comparative safety and adult outcomes are unknown.[10]

→ Z-plasty: adaptable to severity; 98% primary healing in a mixed pediatric series.[18]

→ Heineke-Mikulicz scrotoplasty: an alternative for selected uncircumcised children with isolated webbing; in a 40-child randomized comparison, it was faster than Z-plasty, while recurrent webbing was 3/20 versus 1/20 (p = 0.605).[29]

→ Scrotal-raphe approach: avoids flaps and grafts; no recurrence in 11 webbed penises.[6]

XI. Evidence Summary​

FeatureCurrent evidence
Level of evidenceAdult standalone web correction: chiefly case series and technique descriptions (Level IV). Pediatric isolated web correction: one 40-child randomized Z-plasty versus Heineke-Mikulicz comparison. Two randomized prosthesis studies tested bundled lengthening maneuvers.[29][14][16]
Systematic reviews2: Thomas & Navia 2021; Schifano 2022
Direct randomized web-correction comparisonIn 40 uncircumcised children with isolated congenital webbing, Z-scrotoplasty and Heineke-Mikulicz scrotoplasty had recurrent webbing in 1/20 and 3/20, respectively, through scheduled 12-month follow-up (p = 0.605); three Heineke-Mikulicz patients needed redo Z-plasty.[29]
Largest Z-plasty seriesÁlvarez Vega 2025 (100 procedures, pediatric, mixed penile and scrotal indications)
Largest IPP + scrotoplasty seriesGupta 2019 (n = 103 scrotoplasties using multiple techniques with initial IPP insertion)[20]
Validated outcome measuresNone specific to cosmetic web correction
Standardized classificationEl-Koutby (congenital only); no adult classification
Position statementsSMSNA 2024 does not address isolated web correction. In its section on congenital intrinsic penile shortness, the 2026 EAU guideline gives a weak recommendation to use ventral phalloplasty among lengthening procedures and a strong recommendation for extensive complication counseling.[23][31]

XII. Clinical Summary​

Small series describe some penoscrotal-web techniques as straightforward, but reported morbidity varies by technique and setting.[2][10] In a randomized trial of 40 uncircumcised children, recurrent webbing occurred in 4/40 through 12 months, including three cases requiring redo Z-plasty; adult standalone series remain small and short term.[29][5] The short-term, nonrandomized penile-prosthesis comparison reported perceived shortening in 31/37 (84%) patients without web release (assessed from clinical records) and perceived length gain in 36/43 (84%) with release at 3 months.[2] For standalone cosmetic correction, the Thomas & Navia algorithm proposes Z-plasty at the penoscrotal junction, and a mixed pediatric series reported 98% primary flap healing.[4][18] In one retrospective IPP/scrotoplasty cohort, diabetes (OR 6.1) and V-Y plasty (OR 4.9) were separate associations with wound dehiscence.[20] The V-I reconfiguration was described as a simple closure; in a retrospective series of 21 children, no postoperative complications were reported with assessments through 12 months, while comparative safety remains unknown.[10] The evidence base remains limited, dominated by case series and technique descriptions, and no validated outcome measures, standardized adult classification systems, or large prospective standalone cosmetic-correction studies exist.[1][4]

See Also​

References​

1. Schifano N, Castiglione F, Cakir OO, Montorsi F, Garaffa G. Reconstructive surgery of the scrotum: a systematic review. Int J Impot Res. 2022;34(4):359–368. doi:10.1038/s41443-021-00468-x

2. Miranda-Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile-implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile-implant surgery. J Sex Med. 2007;4(5):1494–1499. doi:10.1111/j.1743-6109.2007.00551.x

3. Caso J, Keating M, Miranda-Sousa A, Carrion R. Ventral phalloplasty. Asian J Androl. 2008;10(1):155–157. doi:10.1111/j.1745-7262.2008.00365.x

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