The Role of Plastic Surgery in Urologic Cancer and Trauma Reconstruction: A Systematic Review.

Abstract

The role of plastic surgeons in urologic reconstruction following malignancy and trauma remains poorly defined despite potential synergies in complex cases requiring specialized reconstructive techniques. Systematic literature search of PubMed, Medline/Ovid, and Cochrane databases using predetermined search terms combining "plastic surgery" with urologic cancer and trauma keywords. Studies were included if both urologic and plastic surgeons were involved in clinical care. Four studies met inclusion criteria from 46 initial references, representing diverse applications from 2021 to 2025. Key findings included the following: (1) complex abdominal wall reconstruction following retroperitoneal sarcoma resection using biologic mesh and omental flaps; (2) plastic surgery involvement in 33% of scrotal squamous cell carcinoma and 67% of extramammary Paget's disease cases undergoing Mohs surgery with low recurrence rates; (3) microsurgical lymphovenous bypass for lymphedema following inguinal lymphadenectomy in penile cancer patients; and (4) gracilis muscle flap interposition for rectourethral fistula repair, demonstrating significantly improved healing rates with systematic multidisciplinary protocols (100% vs 66%, P = 0.04). Limited but compelling evidence supports plastic surgery involvement in complex urologic reconstruction, particularly for extensive oncologic resections, scrotal malignancies, lymphedema management, and complex fistula repair. Systematic multidisciplinary approaches demonstrate improved outcomes, although further research is needed to establish optimal protocols and cost-effectiveness.