Benign penile skin anomalies in children: a primer for pediatricians

Congenital webbed penis: Surgical outcomes of a simplified technique

BACKGROUND

Webbed penis is a cause of concealed penis. It reflects abnormal attachment of the scrotal skin to different ventral penile shaft levels, possibly due to abnormal scrotal dartos insertion. Different techniques are available for correction of congenital webbed penis. However, there is no single one versatile for correction of different grades.

OBJECTIVE

To evaluate the surgical outcome of penile degloving, excision of abnormal dartos fascia with penoscrotal fixation sutures to correct different grades of congenital webbed penis.

STUDY DESIGN

This prospective study was conducted on boys with congenital webbed penis. Thorough clinical examination to determine the degree of webbed penis and associated anomalies were done. A technical modification of previously described technique by Frenkl et al. 2004 (22) was used. The principles include; complete penile degloving with excision of all abnormal scrotal dartos attached to the penile shaft, creation of a well-defined penoscrotal angle by penoscrotal fixation sutures and the short ventral skin was compensated from the prepuce with circumcision. Assessments of surgical outcomes and parents' satisfaction were done during follow up visits.

RESULTS

This study included 107 boys. The median age was 9 (range, 6-40) months, and the median operative time was 55 (range, 50-65) min. Five patients (4.7%) developed self-limited postoperative penile edema, two (1.9%) developed wound infections, and two (1.9%) had a self-limited scrotal hematoma. The median follow-up period was 19 months. At the 6 months follow-up, we had two patients with persistent mild grade I webs, with a success rate of 98.13%. Parental satisfaction was obtained for all patients.

DISCUSSION

Currently, there is no current single technique suitable for the correction of all grades of webbed penis. In this study, we presented a technical modification of previously described technique by Frenkl et al. 2004 (9), this modified technique is versatile for correction of different grades of congenital webbed penis without leaving a scar at the penoscrotal angle. But, absence of a comparative group is considered a limitation; however, the versatility of this technique overcomes this limitation.

CONCLUSIONS

This described technique is simple and feasible. It could correct all types of congenital webbed penis. Short term outcome showed good cosmetic and functional results with parental satisfaction.

Using two “V” shaped flaps in penile torsion treatment

Introduction:

Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result.

Patient and methods:

Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra.

Results:

Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion.

Conclusions:

Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes.

Level of evidence:

Not applicable for this multicenter audit.

Megaprepuce: A New Surgical Technique with Excellent Cosmetic and Functional Results

Background: Congenital megaprepuce (CMP) is a malformation consisting of redundant inner foreskin, normal penile shaft, and severe phimosis. The excess inner prepuce pushes the penile shaft deeper causing the appearance of a buried penis. We describe a novel surgical technique using dartos fascial flaps to reconstruct the prepuce giving excellent cosmetic and functional results. Patients and Methods: Penile reconstruction was performed by a single surgeon in 07 cases of CMP between January 2018 and December 2019. In all cases, the described surgical technique was used. Following surgery, cosmetic and functional outcomes were reviewed as well as the incidence of complications. The patients' ages ranged from 15 to 27 months (mean = 19). Mean hospital stay was 9 hours (range = 7-12). Operating time was between 50 and 85 minutes. Results: Postoperative appearance of the penis was satisfactory for all the parents in our group. Swelling of the penile shaft was seen in all of our patients but settled within one week of surgery. Scrotal hematoma was seen in only one of our patients, but that also did not need any intervention and settled spontaneously. During the follow-up period (mean = 14.5 months, range 6-24) no patient underwent revision surgery. In all our patients, the final appearance was of a circumcised penis. The final similarity to a normal circumcised penis was excellent in all of our patients. Correction of penoscrotal transposition was done in all patients achieving an elongated penile shaft and almost invisible postoperative scarring. Conclusion: Our modified surgical procedure to correct CMP is a safe and simple technique, providing good cosmetic results with the appearance of a standard circumcised penis. This also provides a good functional outcome with complication rate quite low. This technique is also easy to reproduce and teach compared with other complex procedures.

Phimosis in a 10-yr-old Boy Without Urinary Infection-How to Inform Parents: For Circumcision

Circumcision can be a viable option for phimosis in a 10-yr-old boy, also if asymptomatic, in the presence of skin alterations or if the parents prefer avoid observation. Morbidity is minimal if the procedure is performed in a hospital setting.

Spontaneous Cystic Penile Vascular Malformation in an Adolescent and Review of the Literature

Vascular malformations rarely involve the male genitalia, and even fewer appear as cystic lesions on the penile shaft. We report an uncommon case of spontaneous swelling near the coronal margin of the penis that was found to arise from a vascular malformation. We review the pathologic findings and the literature regarding vascular malformations of the penis and other penile cystic structures that have similar clinical appearance, and discuss treatment options for penile vascular malformations.