A Novel Technique of Concealed Penis Repair

Abstract

Introduction The correction of concealed penis requires challenging surgical techniques. We describe a novel technique involving inner preputial skin substitution after degloving through a ventral approach that allows sufficient penile skin coverage and evaluated the efficacy and safety of our technique.

Methods From February 2009 to March 2009, 12 boys with concealed penises underwent correction via our novel technique. We administered a questionnaire about penile size, morphology, and voiding status to parents to evaluate their satisfaction with the results.

Results The mean age of patients at the time of operation was 4.71 ± 4.01 years, and the mean duration of follow-up was 5.11 ± 1.45 months. Parental satisfaction grades (0 to 4) concerning penile size increased from 1.00 ± 1.04 to 2.83 ± 0.94 (p = 0.002) after surgery, penile morphology from 1.00 ± 0.95 to 3.00 ± 0.85 (p = 0.001), and voiding status from 1.08 ± 1.00 to 3.33 ± 0.78 (p < 0.001) at the last follow-up visit. The parental satisfaction rates regarding postoperative changes in size and morphology were 83.3 and 91.7%, respectively. Nine parents (75%) said they would recommend the surgery to others. There were no complications, including postoperative hematoma, infection, and tissue necrosis.

Conclusion Our method of correcting concealed penis was demonstrated to be technically feasible and safe. It provides a good cosmetic appearance and excellent parental satisfaction ratings regarding size, morphology, and voiding function.

Keywords

penis - urogenital abnormalities - reconstructive surgical procedures

• References

• 1 Maizels M, Zaontz M, Donovan J, Bushnick PN, Firlit CF. Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder. J Urol 1986; 136 (1 Pt 2) 268-271
• 2 Johnston JH. Other penile abnormalities. In: Williams DI, Hohenfellner R, Eckstein HB, , eds. Surgical Pediatric Urology. Stuttgart: Thieme; 1977: 406-413
• 3 Srinivasan AK, Palmer LS, Palmer JS. Inconspicuous penis. ScientificWorldJournal 2011; 11: 2559-2564
• 4 Lee T, Suh HJ, Han JU. Correcting congenital concealed penis: new pediatric surgical technique. Urology 2005; 65 (4) 789-792
• 5 Wollin M, Duffy PG, Malone PS, Ransley PG. Buried penis. A novel approach. Br J Urol 1990; 65 (1) 97-100
• 6 Herndon CD, Casale AJ, Cain MP, Rink RC. Long-term outcome of the surgical treatment of concealed penis. J Urol 2003; 170 (4 Pt 2) 1695-1697 , discussion 1697
• 7 Donahoe PK, Keating MA. Preputial unfurling to correct the buried penis. J Pediatr Surg 1986; 21 (12) 1055-1057
• 8 Radhakrishnan J, Razzaq A, Manickam K. Concealed penis. Pediatr Surg Int 2002; 18 (8) 668-672
• 9 Gillett MD, Rathbun SR, Husmann DA, Clay RP, Kramer SA. Split-thickness skin graft for the management of concealed penis. J Urol 2005; 173 (2) 579-582
• 10 Kojima Y, Hayashi Y, Maruyama T , et al. Correction of completely buried penis using the modified preputial island pedicle flap method. J Pediatr Surg 1999; 34 (10) 1524-1526
• 11 Smeulders N, Wilcox DT, Cuckow PM. The buried penis—an anatomical approach. BJU Int 2000; 86 (4) 523-526
• 12 Brisson P, Patel H, Chan M, Feins N. Penoplasty for buried penis in children: report of 50 cases. J Pediatr Surg 2001; 36 (3) 421-425
• 13 Frenkl TL, Agarwal S, Caldamone AA. Results of a simplified technique for buried penis repair. J Urol 2004; 171 (2 Pt 1) 826-828
• 14 Borsellino A, Spagnoli A, Vallasciani S, Martini L, Ferro F. Surgical approach to concealed penis: technical refinements and outcome. Urology 2007; 69 (6) 1195-1198
• 15 Sugita Y, Ueoka K, Tagkagi S, Hisamatsu E, Yoshino K, Tanikaze S. A new technique of concealed penis repair. J Urol 2009; 182 (4, Suppl): 1751-1754
• 16 Boemers TM, De Jong TP. The surgical correction of buried penis: a new technique. J Urol 1995; 154 (2 Pt 1) 550-552
• 17 Chu CC, Chen YH, Diau GY, Loh IW, Chen KC. Preputial flaps to correct buried penis. Pediatr Surg Int 2007; 23 (11) 1119-1121
• 18 Hägglöf B, Andrén O, Bergström E, Marklund L, Wendelius M. Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. Eur Urol 1998; 33 (Suppl. 03) 16-19
• 19 Shenoy MU, Srinivasan J, Sully L, Rance CH. Buried penis: surgical correction using liposuction and realignment of skin. BJU Int 2000; 86 (4) 527-530