1
|
Singh CS, Kunnur VS, Shantala G, Kumar SKA. Retrograde Progression of Inner Preputial Skin to Overcome Skin Shortage in Cases of Congenital Buried Penis. Afr J Paediatr Surg 2024:01434821-990000000-00027. [PMID: 39316022 DOI: 10.4103/ajps.ajps_119_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 09/25/2024] Open
Abstract
AIM The aim of this study is to report our experience in the treatment of congenital buried penis using a simplified technique of retrograde progression of inner preputial skin for reconstruction and overcome skin shortage. METHODS This is a retrospective multi-institutional study conducted in the Department of Pediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India, and the Department of Paediatric Surgery, Rajiv Gandhi Super Specialty Hospital/Raichur Institute of Medical Sciences, Raichur, Karnataka, India, over a period of 3 years (from March 2019 to February 2022). A total of 14 cases of primary congenital buried penis were operated in the specified period. Age of the patients ranged between 8 months and 9 years. Retrograde progression of the inner preputial skin to provide coverage to the dorsal aspect of penile shaft and ventral transposition of the dorsal penile skin to cover the ventral penile shaft was used as a standard procedure for skin coverage. RESULTS All patients had good-to-excellent outcomes with uniformly improved visualisation of penile shaft post-operatively. There were no significant post-operative complications apart from mild oedema which subsided over a period of 3 weeks. Genital hygiene had significantly improved in all the patients as a result of uninterrupted urinary stream. CONCLUSION Retrograde progression of the inner preputial skin may be used as an effective technique to provide skin coverage to the penile shaft for reconstruction of congenital buried penis. It provides good functional and cosmetic results with adequate parental and patient satisfaction with minimal complications.
Collapse
Affiliation(s)
- Chandra Shekhar Singh
- Department of Paediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India
| | - Vijayamahantesh S Kunnur
- Department of Paediatric Surgery, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - G Shantala
- Department of Paediatric Medicine, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - S K Anil Kumar
- Department of Anaesthesia, Faculty of Medical Sciences, Khaja Bandanawaz University, Kalburgi, Karnataka, India
| |
Collapse
|
2
|
You J, Chen HT, Li S. Surgical correction of congenital megaprepuce: a pilot study. J Int Med Res 2024; 52:3000605231218613. [PMID: 38179706 PMCID: PMC10771063 DOI: 10.1177/03000605231218613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE Congenital megaprepuce (CMP) is a rare penile deformity that usually requires surgical correction. This study was performed to examine the efficacy of the modified Sugita procedure for repairing CMP in pediatric patients. METHODS We retrospectively analyzed the clinical data of pediatric patients with CMP treated by a surgeon using the modified Sugita procedure in our hospital from January 2019 to April 2021. RESULTS Twenty patients were enrolled, and their median age at surgery was 70.5 months (range, 60-96 months). All surgeries were successful, and no complications occurred during the operation. The postoperative foreskin had moderate edema in five patients, and soaking in 10% hypertonic saline resulted in disappearance of the edema within 4 to 8 weeks. The follow-up duration was 6 to 20 months (median, 10 months). No other complications occurred, such as dehiscence or hematoma. CONCLUSIONS The modified Sugita procedure for correction of CMP produces excellent cosmesis and a low complication rate. Our study indicates that the modified Sugita procedure is a safe and feasible treatment option.
Collapse
Affiliation(s)
- Jia You
- Department of Pediatric Urology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No. 100, Hongkong Road, Jiang’an District, Wuhan, Hubei 430016, China
| | - Hai-tao Chen
- Department of Pediatric Urology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No. 100, Hongkong Road, Jiang’an District, Wuhan, Hubei 430016, China
| | - Shuang Li
- Department of Pediatric Urology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No. 100, Hongkong Road, Jiang’an District, Wuhan, Hubei 430016, China
| |
Collapse
|
3
|
Pensabene M, Sergio M, Baldanza F, Grasso F, Serra G, Spataro B, Bonfiglio R, Patti M, Maggiore V, Cambiaso C, Giuffré M, Corsello G, Cimador M, Di Pace MR. Penile Length Assessment of Children Treated for Primary Buried Penis: Can Satisfying Penile Growth Always Be Achieved? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1254. [PMID: 37508751 PMCID: PMC10377962 DOI: 10.3390/children10071254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Primary buried (BP) penis is describes as a small penis caused by a penile ligaments anomaly; it is unclear if a primary BP could reach a normal length. We selected 49 patients treated at our institution between 2015 and 2020 in order to post-operatively evaluate the SPL after one year. SPL was evaluated according to the PH Tanner staging system for pre-pubertal patients according to age-normalized values. A micropenis was detected if the SPL was below 2.5 SD. A normal SPL was found in thirty-two patients, eighteen were in PH Stage 1, four were in PH Stage 2, six were in PH Stage 3, and four were in PH Stage 5. Seventeen patients showed a reduced SPL; in seven of these (four in PH Stage 4 and three in PH Stage 5), their SPL was <2.5 ST. The difference in micropenis prevalence between the pre-pubertal and post-pubertal patients was significant (p = 0.038). A primary BP grows normally during the pre-pubertal period, where patients frequently showed a normal SPL, but it seems to be unable to reach a normal length in the higher PH stages, where the SPL is used to detect a micropenis. We suggest that a primary BP should be considered not as a simple defect of the penile ligaments and surrounding tissues, but as an incomplete manifestation of a micropenis due to a growth slowdown of the organ in late puberty.
Collapse
Affiliation(s)
- Marco Pensabene
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Maria Sergio
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Fabio Baldanza
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Francesco Grasso
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Gregorio Serra
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Benedetto Spataro
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Roberta Bonfiglio
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Maria Patti
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Valentina Maggiore
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Chiara Cambiaso
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Mario Giuffré
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Marcello Cimador
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Maria Rita Di Pace
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| |
Collapse
|
4
|
Caione P, Cavaleri Y, Gerocarni Nappo S, Collura G, Capozza N. The concealed penis: the "two-corner" surgical technique. Minerva Urol Nephrol 2019; 73:122-127. [PMID: 31692304 DOI: 10.23736/s2724-6051.19.03532-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized approach that is suitable for concealed penis and penoscrotal webbing. METHODS From January 2005 to December 2013, patients presenting concealed penis were treated utilizing the "two corners" technique: through a midline penoscrotal incision, the superficial ventral chordee is removed, freeing the corpus spongiosum till the peno-scrotal angle. Circumferential degloving of the shaft is performed and the scrotal septum is separated from the urethra, allowing the penile shaft to pull out. The new peno-scrotal junction is rebuilt downwards, anchoring the peno-scrotal dartos corners to the peripubic tissue bilaterally and stabilizing the penile lengthening. Tension-free skin coverage is allowed by a series of Z-plasty at the penoscrotal angle avoiding circumcision if not needed. RESULTS Forty-nine patients aged 3-14 years (mean age 4.7 years) underwent correction of the concealed penis according to our technique. Of them, 26 were primary and 23 after previous to hypospadias repair or other genital surgery. Penile lengthening varied from 1 to 2.5 cm (median 1.8 cm). Hospital stay varied from 1 to 4 days (mean 1.6 days). Follow-up ranged from 4 to 14 years (median 7.3 years). Forty-five parents were satisfied with the results (92%), while the defect was judged imperfectly repaired in four patients. CONCLUSIONS The "two-corners" technique allows easy and effective correction of the concealed penis in both congenital and acquired conditions. It can be performed as outpatient procedure and results are stable at long-term follow-up.
Collapse
Affiliation(s)
- Paolo Caione
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy -
| | - Yuri Cavaleri
- Unit of Urology, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Simona Gerocarni Nappo
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy
| | - Giuseppe Collura
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy
| | - Nicola Capozza
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy
| |
Collapse
|
6
|
Podestá ML, Podestá M. Megaprepuce Reconstruction: A Single Center Experience. Front Pediatr 2018; 6:64. [PMID: 29616205 PMCID: PMC5869308 DOI: 10.3389/fped.2018.00064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/02/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Surgical treatment of congenital megaprepuce is challenging and controversial. We report our 10-year experience treating patients with this deformity using a standardized procedure that has similarities to a technique reported by Smeulders et al. (1). Our postoperative complications and mid-term follow-up cosmetic appearance of the genitalia after reconstruction are reviewed. MATERIAL AND METHODS Fifteen patients operated on between 2005 and 2015 were evaluated. Age at surgical repair ranged from 3 to 20 months (mean 9). Treatment included unfolding the preputial sac via a ventral approach, excision of redundant inner preputial skin, and ventral skin coverage with the outer preputial layer. Twelve patients presented associated partial scrotal engulfment, which was simultaneously treated. Mean follow-up was 4.6 years (range 2-7 years). RESULTS Short-term complications occurred in three patients: scrotal hematoma in one patient and small skin dehiscence at the penoscrotal junction in two patients. Skin disruption healed by secondary epithelial ingrowth. All cases resulted in a satisfactory genital cosmetic outcome. There were no late complications. All patients preserved normal external genitalia appearance. CONCLUSION Our experience is in agreement with reports of other authors; suggesting that excision of the inner preputial layer and using the external one for penile coverage provide good and durable mid-term esthetic results in megaprepuce reconstruction.
Collapse
Affiliation(s)
- Miguel Luis Podestá
- Urology Unit, Department of Surgery, Hospital de Niños "R Gutiérrez", Buenos Aires, Argentina
| | - Miguel Podestá
- Urology Unit, Department of Surgery, Hospital de Niños "R Gutiérrez", Buenos Aires, Argentina
| |
Collapse
|
9
|
Buried penis: classification surgical approach. J Pediatr Surg 2014; 49:374-9. [PMID: 24528990 DOI: 10.1016/j.jpedsurg.2013.09.066] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 09/07/2013] [Accepted: 09/27/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction. MATERIALS AND METHODS Sixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1-29 patients with Longer Inner Prepuce (LIP) only, Grade II-20 patients who presented with LIP associated with indrawn penis that required division of the fundiform and suspensory ligaments, and Grade III-12 patients who had in addition to the above, excess supra-pubic fat. OPERATIVE APPROACH A ventral midline penile incision extending from the tip of prepuce down to the penoscrotal junction was used in all patients. The operation was tailored according to the BP Grade. All patients underwent circumcision. Mean follow up was 3 years (range 1 to 10). RESULTS All 61 patients had an abnormally long inner prepuce (LIP). Forty-seven patients had a short penile shaft. Early improvement was noted in all cases. Satisfactory results were achieved in all 29 patients in grade I and in 27 patients in grades II and III. Five children (Grades II and III) required further surgery (9%). CONCLUSIONS Congenital buried penis is a spectrum characterized by LIP and may include in addition; short penile shaft, abnormal attachment of fundiform, and suspensory ligaments and excess supra-pubic fat. Congenital Mega Prepuce (CMP) is a variant of Grade I BP, with LIP characterized by intermittent ballooning of the genital area.
Collapse
|
11
|
Alexander A, Lorenzo AJ, Salle JLP, Rode H. The Ventral V-plasty: a simple procedure for the reconstruction of a congenital megaprepuce. J Pediatr Surg 2010; 45:1741-7. [PMID: 20713233 DOI: 10.1016/j.jpedsurg.2010.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 03/31/2010] [Accepted: 03/31/2010] [Indexed: 11/27/2022]
Abstract
A buried penis secondary to a megaprepuce is defined clinically by a phimosis, failure of the corporal bodies to inhabit a variably deficient penile shaft skin and a basal hemispheric ballooning of the penis during micturition. Anatomically, it describes a condition in which a normal phallus is trapped within normal prepubic connective tissue by the excessive skin of a megaprepuce and a variable abundance of dartos fascia. Many surgical procedures have been described to correct this deformity, suggesting that no single method has a clear advantage. Most of them rely on relatively complex skin flaps or on the abnormal megapreputial tissue for reconstruction of the deficient ventral shaft skin. Herein, the authors describe an alternative technique for ventral skin coverage, the Ventral V-plasty. This surgical procedure allowed for the favorable reconstruction of 10 consecutive children with a buried penis secondary to a megaprepuce. This technique is distinguished by its simplicity and consistent, pleasing cosmetic results.
Collapse
Affiliation(s)
- Angus Alexander
- The Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada.
| | | | | | | |
Collapse
|