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Klein RD, Myrga JM, Redinger J, Bastacky SI, Baker EE, Quiroga-Garza GM, Rubin JP, Rusilko PJ. The Role of Suprapubic Superficial Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04182-z. [PMID: 38886196 DOI: 10.1007/s00266-024-04182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Adult-Acquired Buried Penis is a disorder associated with systemic obesity that confers increased risks of malignancy, sexual dysfunction, urinary abnormalities, and psychological distress. Surgical correction improves patient-reported functional and psychological outcomes and often requires collaboration between plastic and urologic surgeons. To improve postoperative cosmetic outcomes and decrease wound complications following adult-acquired buried penis repair, we performed an anatomic and histologic study of the superficial fascial layers providing support to the external male genitalia and describe our approach for fascial reconstruction. METHODS We characterized the superficial fascial anatomy in three patients undergoing adult-acquired buried penis repair, including two patients with Wisconsin Type II disease and one patient with Wisconsin Type IV disease. Gross specimens were sent from two patients histologic analysis using H&E and elastin-specific stains to characterize the identity of the superficial fibrofatty tissue. RESULTS In all three patients, the fundiform ligament overlying the suspensory ligament was identified, isolated, and transected for removal with the suprapubic specimen. We found that reapproximation of this ligament following transection at the time of escutcheonectomy provided significant lift to the penis and genitals via improved support of dartos fascia. Histologic analysis of the superficial fibrofatty tissue located beneath the dermis revealed histologic similarities with the superficial fascial system described previously in abdominal and breast tissue. CONCLUSIONS Reapproximation of the fundiform ligament and superficial fascial tissue following suprapubic/lower abdominal fat pad removal during adult-acquired buried penis may improve postoperative cosmesis by reducing strain on the dermal closure. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Affiliation(s)
- Roger D Klein
- UPMC Department of Urology, UPMC, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA
| | - John M Myrga
- UPMC Department of Urology, UPMC, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA
| | - Juliet Redinger
- UPMC Department of Pathology, UPMC, 1515 Locust St, Pittsburgh, PA, 15219, USA
| | - Sheldon I Bastacky
- UPMC Department of Pathology, UPMC, 1515 Locust St, Pittsburgh, PA, 15219, USA
| | - Evan E Baker
- UPMC Department of Pathology, UPMC, 1515 Locust St, Pittsburgh, PA, 15219, USA
| | | | - J Peter Rubin
- UPMC Department of Plastic Surgery, 3601 Fifth Ave #6B, Pittsburgh, PA, 15213, USA
| | - Paul J Rusilko
- UPMC Department of Urology, UPMC, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA.
- UPMC Department of Plastic Surgery, 3601 Fifth Ave #6B, Pittsburgh, PA, 15213, USA.
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Ngaage LM, Lopez J, Wu Y, Nam A, Boyle K, Rasko Y, Goldberg N. Uncovering the Hidden Penis: A Nomenclature and Classification System. Ann Plast Surg 2021; 86:444-449. [PMID: 32842029 DOI: 10.1097/sap.0000000000002483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A hidden penis can interfere with normal hygiene, prevent effective voiding, restrict sexual activity, and cause great embarrassment to the patient. The terms "hidden," "buried," and "trapped" penis are used interchangeably. To date, there is no classification system that adequately characterizes the spectrum of this condition. In this study, we propose a simplified nomenclature and classification system for adult-acquired hidden penis. METHODS We performed a retrospective review of all adult patients treated surgically for hidden penis by the senior author from 2009 to 2019. Patients were classified into either "buried" or "trapped" categories. A "buried" penis was defined as a hidden penis concealed by suprapubic fat without fibrous tethering. These patients were managed with panniculectomy, monsplasty, or both. In contrast, those with a "trapped" penis presented with scarred or fibrous tissue, which required surgical lysis, phalloplasty, and penile skin resurfacing. RESULTS Thirteen patients met the inclusion criteria. The cohort was aged 53 ± 15.7 years with a mean body mass index of 37.4 ± 4.3 kg/m2. Two patients required repeat operations, yielding a total of 15 operative encounters. Six were defined as buried, and 9 as trapped. Inability to achieve erection was the most common preoperative complaint in those with buried penis (67%), whereas difficulties in voiding were most common with trapped penis (78%). Patients with trapped penises had a significantly larger body habitus than those with a buried penis (39.8 vs 34.2 kg/m2, P = 0.0088). Operative duration and length of hospital stay were comparable between the trapped and buried penis groups (206 vs 161 minutes, P = 0.3664) (5 vs 1 day, P = 0.0836). One third experienced wound complications, but this was not significantly different between buried and trapped penises (17% vs 44%, P = 0.5804). Postoperatively, 5 patients experienced spontaneous erections, and 7 were able to void while standing. CONCLUSIONS Patients with a trapped penis present with a different preoperative symptom profile and body type than those with a buried penis. Our nomenclature and classification system offer a simple and clear algorithm for the management of hidden penis. Large cohort studies are warranted to assess differences in clinical outcomes between trapped and buried penises.
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Affiliation(s)
- Ledibabari Mildred Ngaage
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine
| | | | - Yinglun Wu
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine
| | - Arthur Nam
- Department of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center
| | - Karen Boyle
- Departments of Urology and Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Yvonne Rasko
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine
| | - Nelson Goldberg
- From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine
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3
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Su Q, Gao S, Lu C, Wu X, Zuo L, Zhang L. Clinical effect of Brisson operation modified by Y-shaped incision for treatment of concealed penis in adolescents. J Int Med Res 2021; 49:3000605211005951. [PMID: 33823633 PMCID: PMC8033467 DOI: 10.1177/03000605211005951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the clinical effect of the Brisson operation modified by a Y-shaped incision in treating adolescent concealed penis. METHODS We retrospectively analyzed clinical data of 27 adolescents with a concealed penis treated with the Brisson operation modified by a Y-shaped incision in our hospital from January 2017 to March 2020. RESULTS The operation went smoothly in all 27 patients. Postoperative foreskin edema occurred in 12 patients and spontaneously resolved within 1 month postoperatively. Two patients developed postoperative retropubic infection. After administering antibiotics and symptomatic treatment, both patients' conditions improved within 1 week. All operations obtained satisfactory results. Postoperatively, when the penis was in a non-erect state, it was clearly exposed without retraction or concealment; thus, demonstrating good surgical results. The prepuce was distributed naturally without obvious accumulation of redundant preputial tissue. The penile scar resembled that after circumcision. The postoperative follow-up period was 6 months, during which no patients developed recurrence. CONCLUSION The Brisson operation modified by a Y-shaped incision is effective for treating a concealed penis in adolescent patients. This technique may relieve the pathological abnormalities and retain the penile skin's integrity to the greatest extent with minimal scarring and a satisfactory appearance.
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Affiliation(s)
- Quanxin Su
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Shenglin Gao
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Chao Lu
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xingyu Wu
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Li Zuo
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Lifeng Zhang
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Zhang P, Wang B, Zhang X, Song Z, Bai W, Li Q, Xu T. Suprapubic Liposuction With a Modified Devine's Technique for Buried Penis Release in Adults. Plast Surg (Oakv) 2020; 28:172-178. [PMID: 32879874 DOI: 10.1177/2292550320903440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background With the increasing prevalence of overweight and obesity, adult-acquired buried penis is more common in recent years. Many surgical techniques have been reported. However, none is the gold standard. Objective To evaluate the safety and efficacy of combining suprapubic liposuction and modified Devine's technique for penile lengthening in adult patients with buried penis due to obesity. Methods From September 2015 to June 2018, 26 consecutive suitable patients (mean age: 33 ± 5.7 years, mean body mass index: 29 ± 5.4 kg/m2) with a buried penis received suprapubic liposuction and modified Devine's technique for penis release in our medical centre. A retrospective study was conducted. Their penile length from tip to the skin (flaccid) was measured pre- and post-operatively. The amount of liposuction was also recorded accordingly. Results The mean length of the follow-up on the 26 patients is 18 ± 7.1 months (range 3-33 months). The average amount of liposuction is 450 ± 90.2 mL. The average penile length measured preoperatively, post-operatively (on table), and 3 months after the operation is 2.9 ± 1.3, 7.4 ± 2.1, and 5.3 ± 1.8 cm, respectively. The post-operative penile length had significantly increased by 4.5 ± 1.6 cm (on table) and 2.4 ± 0.7 cm (3 months post-operation) with a P value <.05. No patient had difficulties in sexual intercourse or urination post-operatively. None of the patients were dissatisfied with their surgical outcomes. Conclusions The combination of suprapubic liposuction and modified Devine's technique is a safe and effective method for releasing the buried penis of adults with satisfying outcomes.
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Affiliation(s)
- Peiyang Zhang
- Department of Plastic and Cosmetic Surgery, Peking University Third Hospital, Beijing, People's Republic of China
| | - Baicheng Wang
- Department of Plastic and Cosmetic Surgery, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xiaowei Zhang
- Department of Urology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Ziqi Song
- Department of Urology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wenjun Bai
- Department of Urology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Qing Li
- Department of Urology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, People's Republic of China
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Correction of retractile penis with subcutaneous soft silicone penile implant. Int J Impot Res 2019; 32:317-322. [PMID: 31383992 DOI: 10.1038/s41443-019-0174-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/08/2022]
Abstract
We report a novel solution for patients suffering from adult acquired retractile penis. Three patients complained of retractile penis (when standing) and/or prepubic recession. Physical examination confirmed the shaft of the penis was buried with only the glans visible. All three patients reported lower levels of self-confidence, self-esteem, and sexual confidence prior to their procedure. The three patients received surgical treatment with the insertion of a subcutaneous soft silicone penile implant and two of the three also received removal of the suprapubic fat pad. Over one year post operatively, the penile shaft and glans was visible and appeared natural. All patients reported an increase in self-confidence and self-esteem. The insertion of a subcutaneous soft silicone penile implant may prove to be a viable solution to reverse retractile penis and to increase patient quality of life when compared to more invasive current surgical treatments.
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6
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Anandan L, Mohammed A. Surgical management of buried penis in adults. Cent European J Urol 2018; 71:346-352. [PMID: 30386659 PMCID: PMC6202613 DOI: 10.5173/ceju.2018.1676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/29/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Buried penis is a condition that causes the penis to become hidden beneath the skin. It has a significant impact on quality of life and can present in a variety of ways, with lower urinary tract symptoms and erectile dysfunction being common. Whilst there are several causes, obesity is the most common in adults. Due to the burden that obesity is increasingly presenting to healthcare, buried penis may become more common in the future.The purpose of this article is to provide an overview of the causes, presentation and surgical management of this condition in adults. Material and method A literature review was conducted using urological and plastic surgery articles from PubMed, Embase and Medline. Eighteen studies, published between 1982 and 2016, were included. Results Original research trials discussed the treatment of buried penis in lymphoedema and balanitis xerotica obliterans (BXO), new techniques for fat removal, comparison of grafts and postoperative dressings. Several studies provided broad overviews, although focused on management rather than cause and presentation. Overall, studies suggest that, whilst some causes can only be treated with surgery, others can be modified by lifestyle changes and medical management. Conclusions Buried penis is a complex condition that may take years to treat. Several surgical techniques are available, with patients likely requiring a combination of techniques to treat this problem. This review aims to provide a comprehensive overview of the causes, presentation and surgical management of this condition, in order to further the understanding of clinicians who may be faced with this problem more commonly in the future.
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Affiliation(s)
- Lavanya Anandan
- Luton and Dunstable Hospital, Department of Urology, Luton, United Kingdom
| | - Aza Mohammed
- Luton and Dunstable Hospital, Department of Urology, Luton, United Kingdom
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Strother MC, Skokan AJ, Sterling ME, Butler PD, Kovell RC. Adult Buried Penis Repair with Escutcheonectomy and Split-Thickness Skin Grafting. J Sex Med 2018; 15:1198-1204. [PMID: 29960889 DOI: 10.1016/j.jsxm.2018.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
AIM To describe a technique for surgical correction of adult buried penis, including a technique for skin graft harvesting from the escutcheonectomy specimen itself, with an emphasis on remaining open questions in the literature. METHODS We present our method for surgical correction of adult buried penis with a review of the literature. MAIN OUTCOME MEASURE Components of successful buried penis repair include return of directed voiding, elimination of local skin inflammation and infection, improvement in hygiene, return of sexual functioning, cosmesis, and patient satisfaction. To date, there are no broadly accepted tools for comprehensive measurement of outcomes after buried penis repair. RESULTS Adult buried penis repair is generally associated with excellent rates of satisfaction and improvement in functioning. Currently available data are extremely limited; however, they do suggest that, when in doubt, more aggressive debridement of diseased tissue combined with split-thickness skin grafting may provide superior outcomes. Split-thickness skin grafts are associated with excellent rates of successful graft take, even in cases of severe preoperative pathology and patient comorbidity. Although these grafts come at the cost of some increased surgical morbidity, they are associated with low rates of major complications. Morbidity can be further significantly decreased by harvesting the graft from the excised escutcheon itself, a technique that we present here. CONCLUSION Surgical correction of adult buried penis is safe and effective; however, future work is required to further optimize outcomes and reduce surgical morbidity. Strother MC, Skokan AJ, Sterling ME, et al. Adult Buried Penis Repair with Escutcheonectomy and Split-Thickness Skin Grafting. J Sex Med 2018;15:1198-1204.
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Affiliation(s)
- Marshall C Strother
- University of Pennsylvania, Department of Surgery, Division of Urology, Philadelphia, PA, USA.
| | - Alexander J Skokan
- University of Pennsylvania, Department of Surgery, Division of Urology, Philadelphia, PA, USA
| | | | - Paris D Butler
- University of Pennsylvania, Department of Surgery, Division of Plastic Surgery, Philadelphia, PA, USA
| | - R Caleb Kovell
- University of Pennsylvania, Department of Surgery, Division of Urology, Philadelphia, PA, USA
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9
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Theisen KM, Fuller TW, Rusilko P. Surgical Management of Adult-acquired Buried Penis: Impact on Urinary and Sexual Quality of Life Outcomes. Urology 2018; 116:180-184. [PMID: 29625136 DOI: 10.1016/j.urology.2018.03.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess postoperative patient-reported quality of life outcomes after surgical management of adult-acquired buried penis (AABP). We hypothesize that surgical treatment of AABP results in improvements in urinary and sexual quality of life. METHODS Patients that underwent surgical treatment of AABP were retrospectively identified. The Expanded Prostate Cancer Index (EPIC) questionnaire was completed at ≥3 months postoperatively, and completed retrospectively to define preoperative symptoms. EPIC is validated for local treatment of prostate cancer. Urinary and sexual domains were utilized. Questions are scored on a 5-point Likert scale, with higher scores indicating better quality of life. Preoperative scores were compared with postoperative scores. RESULTS Sixteen patients completed pre- and postoperative questionnaires. Mean time from surgery to questionnaire was 12.6 months. There was a significant improvement in 10 of 12 urinary domain questions and 10 of 13 sexual domain questions. Fourteen of 16 patients (87.5%) reported significant improvement in overall sexual function (median score changed from 1.5 to 5, P <.0001). Similarly, 14 of 16 patients (87.5%) reported significant improvement in overall urinary function (median score changed from 1 to 4, P <.0001). CONCLUSION AABP is a challenging condition to treat and often requires surgical intervention to improve hygiene and function. There are limited data on patient-reported quality of life outcomes. We found that surgical management of AABP results in significant improvements in both urinary and sexual quality of life outcomes.
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Affiliation(s)
- Katherine M Theisen
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Thomas W Fuller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Paul Rusilko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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10
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Angermeier KW. Editorial Comment. Urology 2018; 112:179-180. [DOI: 10.1016/j.urology.2016.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Angermeier KW. Editorial Comment. Urology 2018; 112:185. [DOI: 10.1016/j.urology.2016.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Surgical Management of the Concealed Penis in Adults. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ghanem H, ElKhaiat YI, Motawi AT, AbdelRahman IFS. Infrapubic Liposuction for Penile Length Augmentation in Patients with Infrapubic Adiposities. Aesthetic Plast Surg 2017; 41:441-447. [PMID: 28155063 DOI: 10.1007/s00266-017-0786-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hidden penis, inconspicuous and concealed penis are synonyms for the same entity "buried penis" where the penile shaft is hidden below the surface of the prepubic fat to an extent that gives an impression of a short penis, despite corporeal length being normal. AIM The aim of our work is the reduction in the amount of the suprapubic fat by liposuction to reveal the buried penis and assess the results, patient satisfaction and possible complications. METHODS The procedure of suprapubic liposuction was carried out on ten men who were attending the outpatient clinic of Andrology complaining of small-sized penis. MAIN OUTCOME MEASURES Pre-, immediate (on table) postoperative and 3 months postoperative skin to tip flaccid and stretched penile lengths were measured. Patient satisfaction was assessed using the five-point Likert scale. RESULTS There was a statistically significant increase between the pre- and postoperative flaccid and stretched penile lengths in our patients with a p value <0.001 in both. CONCLUSION An acquired adult buried penis is a correctable problem. Simple buried penis due to excess fat at the mons pubis should be differentiated from other complex cases that may require combined techniques to achieve good results with minor complications. Suprapubic liposuction is a very safe and successful procedure with minor or no complications if performed meticulously. It could improve self-esteem along with the associated physical and esthetic concerns. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hussein Ghanem
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, 8th Labib Elbatanoni, Elmanyal, Cairo, Egypt
| | - Yaser Ibrahim ElKhaiat
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, 8th Labib Elbatanoni, Elmanyal, Cairo, Egypt
| | - Ahmed T Motawi
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, 8th Labib Elbatanoni, Elmanyal, Cairo, Egypt
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Incidence of Urethral Stricture in Patients with Adult Acquired Buried Penis. Adv Urol 2017; 2017:7056173. [PMID: 28465682 PMCID: PMC5390610 DOI: 10.1155/2017/7056173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/05/2017] [Accepted: 03/13/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. Concealed-buried penis is an acquired condition associated with obesity, challenging to both manage and repair. Urethral stricture is a more common disorder with multiple etiologies. Lichen sclerosus is a significant known cause of urethral stricture, implicated in up to 30%. We hypothesize that patients with buried penis have a higher rate of urethral stricture and lichen sclerosus than the general population. Methods. We retrospectively reviewed a single surgeon's (CM) case logs for patients presenting with a buried penis. All patients were evaluated for urethral stricture with cystoscopy or retrograde urethrogram either prior to or at the time of repair for buried penis. Those that had surgical repair or biopsy were reviewed for presence of lichen sclerosus. Results. 39 patients met inclusion criteria. Of these, 13 (33%) had associated stricture disease. The location of the strictures was bulbar urethra (38%), penile urethra (15%), and meatus or fossa navicularis (62%). Five patients had lichen sclerosus and urethral stricture disease, while 3 had lichen sclerosus without stricture. 11/13 stricture patients were treated. Six underwent dilation, 3 underwent meatotomy, and 2 underwent urethroplasty. No significant recurrences of stricture were seen. Conclusion. Patients with a concealed penis are more likely than the general population to have a urethral stricture and/or LS. Patients presenting with concealed penis should also be evaluated for a urethral stricture.
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Doiron P, Bunker C. Obesity-related male genital lichen sclerosus. J Eur Acad Dermatol Venereol 2016; 31:876-879. [DOI: 10.1111/jdv.14035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- P.R. Doiron
- Department of Dermatology; Chelsea and Westminster Hospital NHS Foundation Trust; London UK
- University College London Hospitals NHS Foundation Trust; Dermatology Department; University College Hospital London; London UK
| | - C.B. Bunker
- Department of Dermatology; Chelsea and Westminster Hospital NHS Foundation Trust; London UK
- University College London Hospitals NHS Foundation Trust; Dermatology Department; University College Hospital London; London UK
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Boonjindasup A, Pinsky M, Stewart C, Trost L, Chaffin A, Jansen D, Hellstrom W. Management of adult concealed penis using a meshed, split-thickness skin graft. Can Urol Assoc J 2016; 10:E407-E411. [PMID: 28096930 DOI: 10.5489/cuaj.3787] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Concealed penis (CP) is a rare problem faced by urologists and plastic surgeons. CP occurs secondary to trauma, obesity, or infection. Surgical treatment is individualized and based on patient and provider variables. We aim to review our recent experience using meshed split-thickness skin grafting (STSG) for CP management. METHODS A retrospective review was performed on patients who underwent STSG for CP at our institution. Records were reviewed for demographic, operative, and postoperative variables. Preoperative and postoperative photos were obtained to monitor cosmetic results. RESULTS Eleven patients underwent CP release with meshed STSG placement. All cases showed improved functional phallic length and good cosmetic results, regardless of etiology. CONCLUSIONS STSG is a viable option for penile coverage for management of this difficult-to-treat CP population. This primary or salvage modality offers excellent cosmetic results and may be used following prior reconstructive attempts.
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Affiliation(s)
- Aaron Boonjindasup
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Michael Pinsky
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Carrie Stewart
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Landon Trost
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, United States; Department of Urology, Mayo Clinic, Rochester, MN, United States
| | - Abigail Chaffin
- Department of Plastic Surgery, Tulane University School of Medicine, New Orleans, LA, United States
| | - David Jansen
- Department of Plastic Surgery, Tulane University School of Medicine, New Orleans, LA, United States
| | - Wayne Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, United States
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Bryk DJ, Yamaguchi Y, Zhao LC. Tissue transfer techniques in reconstructive urology. Korean J Urol 2015; 56:478-86. [PMID: 26175866 PMCID: PMC4500804 DOI: 10.4111/kju.2015.56.7.478] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/05/2015] [Indexed: 01/15/2023] Open
Abstract
Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques.
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Affiliation(s)
- Darren J Bryk
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Yuka Yamaguchi
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
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Westerman ME, Tausch TJ, Zhao LC, Siegel JA, Starke N, Klein AK, Morey AF. Ventral Slit Scrotal Flap: A New Outpatient Surgical Option for Reconstruction of Adult Buried Penis Syndrome. Urology 2015; 85:1501-4. [PMID: 25872692 DOI: 10.1016/j.urology.2015.02.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We present a novel technique using ventral slit with scrotal skin flaps (VSSF) for the reconstruction of adult buried penis without skin grafting. TECHNICAL CONSIDERATIONS An initial ventral slit is made in the phimotic ring, and the penis is exposed. To cover the defect in the ventral shaft skin, local flaps are created by making a ventral midline scrotal incision with horizontal relaxing incisions. The scrotal flaps are rotated to resurface the ventral shaft. Clinical data analyzed included preoperative diagnoses, length of stay, blood loss, and operative outcomes. Complications were also recorded. Fifteen consecutive patients with a penis trapped due to lichen sclerosus (LS) or phimosis underwent repair with VSSF. Each was treated in the outpatient setting with no perioperative complications. Mean age was 51 years (range, 26-75 years), and mean body mass index was 42.6 kg/m(2) (range, 29.8-53.9 kg/m(2)). The majority of patients (13 of 15, 87%) had a pathologic diagnosis of LS. Mean estimated blood loss was 57 cc (range, 25-200 cc), mean operative time was 83 minutes (range, 35-145 minutes), and all patients were discharged on the day of surgery. The majority of patients (11 of 15, 73.3%) remain satisfied with their results and have required no further intervention. Recurrences in 3 of 15 (20.0%) were due to LS, panniculus migration, and concealment by edematous groin tissue; 2 of these patients underwent subsequent successful skin grafting. CONCLUSION VSSF is a versatile, safe, and effective reconstructive option in appropriately selected patients with buried penis, which enables reconstruction of penile shaft skin defects without requiring complex skin grafting.
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Affiliation(s)
- Mary E Westerman
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy J Tausch
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lee C Zhao
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jordan A Siegel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nathan Starke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alexandra K Klein
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Management of Concealed Penis With Modified Penoplasty. Urology 2015; 85:698-702. [DOI: 10.1016/j.urology.2014.06.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 11/22/2022]
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