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Wang J, Ni J, Xu Y, Yu W, Xu ZP, Dai YT, Yang YQ, Zhao XZ. "A diamond-shaped" penoplasty technique with or without concurrent suprapubic liposuction for adult-acquired buried penis: clinical outcomes and patient satisfaction rates. Asian J Androl 2024:00129336-990000000-00237. [PMID: 39225002 DOI: 10.4103/aja202476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m-2. In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.
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Affiliation(s)
- Jing Wang
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Jian Ni
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Yang Xu
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Wen Yu
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Zhi-Peng Xu
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Yu-Tian Dai
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Yi-Qiong Yang
- Department of Emergency, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Xiao-Zhi Zhao
- Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
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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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Seitz AJ, Edalatpour A, Israel JS, Grimes MD, Williams DH, Poore SO. Postoperative Outcomes following Buried Penis Reconstruction: A Single-Institution Experience Using the Wisconsin Classification System. Plast Reconstr Surg 2024; 153:1151-1160. [PMID: 37337329 DOI: 10.1097/prs.0000000000010868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Adult acquired buried penis (AABP) is a complex condition often necessitating surgical intervention. This study sought to examine the validity of the Wisconsin Classification System (WCS) in guiding the surgical management of AABP. In addition, the authors aimed to identify which factors contribute to postoperative complications and persistent symptoms following AABP repair. METHODS The authors retrospectively reviewed all patients who underwent surgical repair of AABP from 2015 to 2021 by the senior author at our institution. Patients were categorized according to anatomical characteristics using the WCS. Preoperative symptoms, postoperative symptoms, and postoperative complications were evaluated. RESULTS Fifty-two patients underwent AABP repair. The mean patient age was 56.5 ± 14.8 years, and the mean duration of follow-up was 350.0 ± 517.4 days. The assigned preoperative WCS score was congruent with operative management in most patients (86.0%). Morbid obesity (body mass index >40.0 kg/m 2 ) and postoperative complications were associated with persistent symptoms following AABP repair ( P = 0.026 and P = 0.021, respectively). Increased WCS score was not associated with persistent postoperative symptoms ( P = 0.314). Morbid obesity ( P = 0.003), diabetes ( P = 0.029), and having a panniculectomy during AABP repair ( P = 0.046) increased the odds of developing postoperative complications. Patients with type I AABP had significantly fewer complications than those with type II, III, or IV AABP ( P = 0.032). CONCLUSIONS The WCS serves as a preoperative guide and an educational tool for patients, and it provides a framework for the discussion of intraoperative maneuvers and the likelihood of complications. It is imperative that patients are counselled on the surgical management of AABP and the postoperative course, as this may permit realistic patient expectations and optimize outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
| | | | | | - Matthew D Grimes
- Department of Urology, University of Wisconsin School of Medicine and Public Health
| | - Daniel H Williams
- Department of Urology, University of Wisconsin School of Medicine and Public Health
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Schifano N, Cakir OO, Castiglione F, Montorsi F, Garaffa G. Multidisciplinary approach and management of patients who seek medical advice for penile size concerns: a narrative review. Int J Impot Res 2022; 34:434-451. [PMID: 34045688 DOI: 10.1038/s41443-021-00444-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 02/04/2023]
Abstract
We aimed to provide an overview of the strategies available to manage patients concerned about their penile size and to provide useful surgical hints regarding the most common penile enlargement approaches, based on our surgical expertise in this field. A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning penile enlargement issues. The search strategy included a range of keywords; e.g. penis, penile, enlargement, augmentation, lengthening, girth. Management of penile size-related concerns represents a real challenge for the urologist, especially when dealing with patients suffering from penile dysmorphophobic disorder (PDD). A multidisciplinary preoperative assessment, including a psychiatric/psychological evaluation, may help in discerning those patients who would benefit the most from counselling/conservative management from those who would benefit from surgery instead. Conservative approaches include the use of vacuum-based and penile-stretching devices, which have shown encouraging levels of efficacy and safety. Over the last decades, different surgical strategies have been developed, aimed at either increasing flaccid penile length or improving penile girth. Penile lengthening procedures are more established, and satisfactory results can be achieved by experienced, large referrals' volume, surgeons. To date, there is lack of consensus regarding the penile girth enhancing techniques, and therefore these should be regarded as experimental. A multidisciplinary approach is necessary to identify patients with PDD, who should not be offered surgical intervention and should be referred for psychiatric/psychological counselling instead. The surgical approach should be tailored to the subject's unique anatomy and underlying conditions.
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Affiliation(s)
- Nicolò Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Omer Onur Cakir
- Institute of Andrology, Department of Urology, University College London Hospitals NHS Trust, London, UK.,Division of Surgery and Interventional Science, UCL, London, UK
| | - Fabio Castiglione
- Institute of Andrology, Department of Urology, University College London Hospitals NHS Trust, London, UK.,Division of Surgery and Interventional Science, UCL, London, UK
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Adult-Acquired Buried Penis Classification and Surgical Management. Urol Clin North Am 2022; 49:479-493. [DOI: 10.1016/j.ucl.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Noble-Jones R, Thomas MJ, Gabe-Walters M. The education needs of health professionals conservatively managing genital oedema: UK survey findings. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S18-S26. [PMID: 33983806 DOI: 10.12968/bjon.2021.30.9.s18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adults and children report genital oedema but prevalence is unknown. Pre-registration nurse training rarely includes genital oedema and postgraduate training opportunities are rare. AIM To identify the education needs of health professionals regarding management of genital oedema. METHOD An electronic survey was cascaded to health professionals through relevant professional groups and social media. FINDINGS Of 149 UK respondents, most manage patients with genital oedema but only 2% felt current training was sufficient. Of 138 responding regarding supplemental training, only a half had completed genital oedema specific education, usually of 1-4 hours' duration. Confidence in knowledge was up to 22.5% higher in those with genital oedema education, even accounting for years of experience. The most common top three individual needs were compression, contemporary surgical and medical management and patient assessment. Educational resources are needed and both offline and online formats were suggested; collaborative events with urology/pelvic health are essential. CONCLUSION Health professionals working in lymphoedema care have (unmet) specific education needs regarding genital oedema management. The desire for both offline and online resources reflects the necessity of accessing learning at a distance and on an 'as needed' basis.
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Affiliation(s)
- Rhian Noble-Jones
- National Lymphoedema Research Specialist, Lymphoedema Network Wales; Associate Lecturer, Swansea University; Lecturer, University of Glasgow
| | - Melanie J Thomas
- National Clinical Lead/Associate Director for Lymphoedema in Wales, Lymphoedema Network Wales
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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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Abstract
Buried penis is a condition where the penis is hidden by abdominal or suprapubic skin or fat. In adult men, buried penis occurs as an acquired condition most commonly caused by morbid obesity. The clinical characteristics of three obese men with adult acquired buried penis are described and the associated features of the buried penis are reviewed. In addition to morbid obesity, a buried penis can result from other etiologies, such as hidradenitis suppurativa, iatrogenic causes such as elective surgeries, infections, lichen sclerosus, penoscrotal lymphedema, and traumatic events. Lower urinary tract symptoms, such as voiding, and post-voiding problems are the most common presenting complaints; however, bacterial and fungal infections, phimosis, psychological issues, and sexual dysfunction, are also buried penis-related symptoms. The evaluation of a man with adult acquired buried penis begins with a detailed history for condition-related symptoms. Examination of the patient, both standing and supine with an attempt to demonstrate the penis using digital compression of the surrounding skin and fat, should be performed to determine the extent of the problem and whether comorbid conditions-such as infection and lichen sclerosus-are present. Both buried penis and lichen sclerosus can predispose to the development of penile squamous cell carcinoma; the diagnosis of this tumor can be delayed in men with adult acquired buried penis since an adequate penile examination is difficult or impossible. A multidisciplinary approach-including surgeons, primary care physician, registered dietitian nutritionist, and psychiatrist-should be considered for a patient with a buried penis. The surgical management is individualized and based on not only the extent of the problem but also whether an associated condition, such as urethral stricture, is present. Most patients are pleased with the functional and aesthetic outcome following surgery.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Gao B, Bo Q, Lu J, Xiao K. Effect of surgical repair of acquired buried penis on sexual function in adults. Int Urol Nephrol 2020; 52:1087-1091. [PMID: 31993887 DOI: 10.1007/s11255-020-02374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/02/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE This study was performed to investigate the effect of surgical repair of acquired buried penis on sexual function in adults and provide a reference for clinical treatment. METHODS Thirty-two adult patients who underwent surgical treatment of buried penis from August 2010 to August 2017 were selected as the study group. The basic operative method was penile lengthening. Suprapubic liposuction, suspensory ligament release, and preputial plasty were performed according to the clinical manifestations. The changes in erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction sexual function were evaluated according to the International Index of Erectile Function (IIEF) before and after treatment. RESULTS All 32 patients were analyzed by the IIEF before and after the operation. The results showed statistically significant differences in sexual function before and after the operation (P < 0.05). CONCLUSION Surgical repair of acquired buried penis in adults can significantly improve patients' sexual function.
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Affiliation(s)
- Bowen Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qitao Bo
- Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong, China
| | - Junxu Lu
- Institute of Plastic Surgery, Weifang Medical University, Weifang, Shandong, China
| | - Kaiyan Xiao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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