Surgical Management of Adult-acquired Buried Penis: Impact on Urinary and Sexual Quality of Life Outcomes

The Role of Suprapubic Superficial Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis

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 .

Postoperative Outcomes following Buried Penis Reconstruction: A Single-Institution Experience Using the Wisconsin Classification System

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.

Surgical management of adult acquired buried penis syndrome: A systematic review of patient-reported outcome instruments

PURPOSE

Adult acquired buried penis (AABP) is a morbid condition often necessitating surgical intervention. Accurate assessment of pre- and postoperative symptoms is crucial to understand how AABP impacts a patients' quality of life, verify surgical effectiveness, and practice patient-centered care. There is no validated patient-reported outcome instrument specific for AABP evaluation. We undertook a comprehensive review of existing literature on patient-reported outcome instruments post-AABP surgery to highlight the importance of developing a specific tool.

METHODS

Following the preferred reporting items for systematic reviews and meta-analysis 2020 guidelines, we queried three databases using relevant keywords (e.g., "buried penis repair"). Inclusion criteria were studies that discussed surgical management of AABP with patient-reported outcomes. Pediatric and congenital cases were excluded. Information collected included study design, level of evidence, number of participants included in the study, etiology of buried penis, surgical technique, preoperative or postoperative patient-reported outcomes, and patient-reported outcome instrument used.

RESULTS

Initial query identified 998 records. After abstract screening and applying the inclusion or exclusion criteria, a total of 19 articles with 440 patients were included. Eight studies implemented patient-reported outcome instruments. The international index of erectile dysfunction-5 and Likert satisfaction scales were used most frequently. Although all instruments were validated, none were validated in the specific context of AABP surgical intervention.

CONCLUSIONS

There is considerable heterogeneity within the AABP literature regarding patient symptomatology, postoperative complications, patient-reported outcomes, and instruments used. The results of this study emphasize the need for a patient-reported outcome measure to examine the influence of AABP repair on patient satisfaction and health-related quality of life.

No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis

Adult Acquired Buried Penis (AABP) is a pathological condition necessitating surgical correction, ranging from simple to complex procedures involving the utilization of full-thickness (FTSG) or split-thickness (STSG) skin grafts especially in cases of substantial viable penile skin loss. In this retrospective study, we aimed to compare the surgical, functional, and patient-reported outcomes (PROs) of graft types that were utilized to treat AABP among 39 patients at a single center between November 2017 and May 2023. Among these patients, 22 needed skin grafts, with 9 undergoing FTSG and the remainder receiving STSG. Lichen Sclerosus (LS) was the primary cause (54.6%) of AABP requiring skin grafts. Patients primarily presented with voiding (63.6%) and sexual (27.3%) dysfunction. The STSG group had a lower mean age (64.7 ± 11.6) than the FTSG group (66.7 ± 11.6; P = 0.015), with no significant differences in BMI (p = 0.643). Complex repairs (Santucci grade ≥3) were performed in 81.0% of cases, with 88.9% in the FTSG group and 75.0% in the STSG group. Operative times were similar (160.2 ± 31.7 vs 161.5 ± 50.3, p = 0.945). No significant differences in preoperative penis length were found between the FTSG and STSG groups (P = 0.918). Postoperative complications occurred in 36.4% of patients, with severe complications (Clavien grade ≥3) in 9.1%. General postoperative complications and recurrence rates did not significantly differ between groups (P = 0.397 and 0.375; respectively). Functional outcomes, evaluated using the International Index of Erectile Function and the International Prostate Symptom Score, improved significantly in both groups after surgical procedures (P < 0.001 for all). Patient-reported satisfaction for the operation was 81.3% calculated by ad-hoc questionnaire. In conclusion, no discernible differences in outcomes were observed between STSG and FTSG. Larger comparative studies with extended follow-up periods and validated questionnaires are warranted for confirmation. Physicians should consider specialized centers for AABP surgical repair due to its intricacies.

The outcomes of surgical management options for adult acquired buried penis

Functional and surgical outcomes after surgical correction of adult acquired buried penis (AABP) are limited in the current literature. We retrospectively recruited patients underwent surgical treatment of AABP in a single institution from 2017 to 2021. Surgical repair was classified according to surgical complexity following Pariser-Santucci's classification. The primary endpoint of the study was the recurrence-free rate survival. The secondary endpoints were surgical, functional and patients' reported outcomes. Overall 28 patients were included in the study. Median follow-up was 27.5 (18.5-34.5). The most common complaints at presentation were sexual (53.6%) and voiding (39.3%) dysfunction. Surgical management steps ranged from circumcision to more complex procedures, such as suprapubic fat pad excision, abdominoplasty and/or penile shaft skin grafting. Overall postoperative complications were recorded in 32.1%. High-grade complications (Clavien≥3) occurred in 7.1%. One-year recurrence-free survival was 88.7%. Postoperatively IPSS and IIEF-15 questionnaires showed a significant improvement in urinary 8 (0-12) vs 2 (0-3), p = 0.03 and sexual function 37 (23-68) vs 68 (45-72), p = 0.001 respectively. Overall, patients reported functional improvement and 93.8% experienced a positive impact of QoL. AABP surgical repair, despite the high incidence of complications, seems to allow satisfactory outcomes and a significant improvement in patients' QoL.

The concealed morbidity of buried penis: a narrative review of our progress in understanding adult-acquired buried penis as a surgical condition

Adult acquired buried penis (AABP) is a condition of entrapment of the phallus resulting most commonly from morbid obesity and formation of cicatrix with other etiologies including genital lymphedema, hidradenitis and trauma. The incidence of this syndrome is invariably connected to the increasing prevalence of obesity. The purpose of this review is to examine the current literature in AABP with a focus on the morbidity of AABP and perioperative management. The discussion and literature surrounding buried penis reconstruction started with the goal of correcting a cosmetic problem and has recently become fairly successful in this aim with an over 85% rate of successful reconstruction in many series with a more uniform surgical approach. The most recent trends have examined the significant burden of morbidity and even mortality that AABP can place on patients as it contributes to risk of penile cancer, urethral strictures and mood disorders. Studies in this space have shown that surgical repair can be successful in improving quality of life for patients with AABP and the removal of the offending pathophysiology suggests its success in correcting the physical morbidities. New directions for research and management of this condition should include a focus on educating providers and patients to make reconstruction more accessible to patients in need as AABP continues to journey toward mainstream acceptance as a surgical condition.

Uncovering the Hidden Penis: A Nomenclature and Classification System

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.

Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis?

Purpose

A buried penis causes voiding dysfunction and limits penetrative sexual intercourse. This pilot study evaluates the urinary outcomes in men with buried penis following insertion of malleable penile implants.

Materials and Methods

Men with buried penis and co-existing urinary problems and erectile dysfunction underwent malleable penile prosthesis implantation were reviewed in a prospective ethics approved database. Patient demographics, flow rate (Qmax), International Prostate Symptom Score (IPSS), Patient Global Impression of Improvement (PGI-I) score, International Index of Erectile Function (IIEF)-5 score, Sexual Encounter Profile (SEP) and overall satisfaction score (on a 5-point scale) were recorded.

Results

A total of 12 men (age 55 to 72 years) were reviewed, and the average gain in penile length post-implant, as measured from the pubis to the tip of the glans penis, was 6.8 (3 to 8) cm. There was a significant improvement in IIEF-5 score (8.2 vs. 22.5; p=0.029) post-implant, and more than half of patients were able to resume normal sexual intercourse and positive SEP-2 and SEP-4 were reported in 9 (75%) and 8 (67%) patients. There were no significant intraoperative or postoperative complication. Significant improvement in Qmax (8.4 ml/s vs. 18.6 ml/s; p=0.042) and IPSS (24.5±5.5 vs 15.5±3.5; p=0.038) were observed. More than two-thirds (83%) reported PGI-I score at 1 or 2, while 9 (75%) patients scored a 5/5 in overall satisfaction rate.

Conclusions

Malleable penile implants increases penile length and improves urinary function in a highly select group of men with a buried penis and erectile dysfunction.

Surgical management and outcomes of adult acquired buried penis with and without lichen sclerosus: a comparative analysis

PURPOSE

Adult acquired buried penis (AABP) can present with concomitant Lichen Sclerosus (LS), a chronic dermatosis that may affect surgical outcomes. Our aim was to evaluate outcomes of patients undergoing AABP repair with and without LS.

METHODS

A retrospective cohort study was performed for AABP repair patients at a single institution from 1/1991 to 12/2017. Patient characteristics and surgical and peri-operative outcomes, including success, erectile function, and complications, were collected.

RESULTS

Sixty-seven AABP patients with mean follow-up of 16.1 ± 20.4 months were identified. Overall surgical success was 91%. Overall surgical complication rate was 50.7% (23.9% Clavien-Dindo ≥ 3). Forty-two (62.7%) patients had concomitant LS. A higher proportion of patients with LS required a STSG (90% vs 60%, p = 0.005). There was no difference in surgical success (90.5% vs 92.0%, p = 0.999), overall complication rate (57.1% vs 40.0%, p = 0.212), Clavien-Dindo ≥ 3 complications (23.8% vs 24.0%, p = 0.999) or early complications (35.7% vs 32.0%, p = 0.797) between patients with and without LS, respectively. However, a higher proportion of patients with LS experienced late complications (33.3% vs 8.0%, p = 0.020), which were mainly related to wound healing. Satisfaction with erectile function was higher among patients with LS (59.5% vs 320%, p = 0.043).

CONCLUSION

AABP patients with LS behave somewhat differently than their non LS counterparts. They are more likely to require skin graft during surgical treatment. Though surgical success and complications are similar, they do experience a higher rate of late complications from impaired wound healing. Work on improving wound healing in this population should be considered.

Buried penis repair: tips and tricks

Obesity is increasing in prevalence worldwide and an increasingly commonly encountered condition is adult acquired buried penis (AABP). We review the current management of AABP and relevant literature. Management of AABP requires a combination of genitourinary reconstructive techniques and plastic surgery techniques that are unique to this condition. We offer our experience and tips and tricks for the treatment of AABP.

Effect of surgical repair of acquired buried penis on sexual function in adults

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.

Predictors of surgical complications and evaluation of outcomes after surgical correction of adult-acquired buried penis

OBJECTIVE

To determine predictors for surgical complications and assess patient satisfaction after surgical treatment of Adult-Acquired Buried Penis (AABP).

METHODS

A retrospective review was performed on all patients diagnosed with AABP who underwent surgical treatment at a single institution from January 2013-December 2017. Patient demographics and peri-operative data were extracted. Univariate and multivariate regression analyses were performed to identify predictors for surgical complications. Patients' post-operative satisfaction was likewise assessed for factors such as successful outcome, post-operative erection quality, and complications related to the surgery.

RESULT

Twenty-four patients of median age 61.5 years (IQR 54-67) with median follow-up of 12 months (IQR 3.25-29) were included. Overall success was 87.5% (21/24). Complications occurred in 15 (62.5%) patients with 7 (29%) Clavien-Dindo category ≥ 3. Based on regression analyses, body mass index (BMI) ≥ 40 (HR 25; 95% CI 1.45-431.81) and tobacco smoking (HR 14.6; 95% CI 1.15-199.98) were identified as independent predictors of overall complications. Concomitant performance of abdominal panniculectomy was associated with Clavien-Dindo category ≥ 3 (HR 28; 95% CI 2.4-326.74) complications. Patient satisfaction was associated with surgical success (p < 0.0001), post-operative erection (p < 0.027), and absence of surgical morbidity that needed further surgical intervention (p = 0.032).

CONCLUSION

Surgical management of AABP following an individualized algorithm results in a high success rate but also in relatively high procedure-related morbidity. Peri-operative BMI ≥ 40 and tobacco smoking have higher odds for overall complication occurrence, while concomitant abdominal panniculectomy results in more occurrence of Clavien-Dindo category ≥ 3 morbidities. Patient's eventual satisfaction correlates well with surgical success, post-procedural erection condition, and lack of Clavien-Dindo ≥ 3 morbidity.

The Surgical Treatment of Adult Acquired Buried Penis Syndrome: A New Classification System

BACKGROUND

Adult acquired buried penis syndrome may be associated with an inability to void, sexual dysfunction, and recurrent infection. Previously published classification systems rely on intraoperative findings, such as penile skin quality.

OBJECTIVES

The purpose of this study was to evaluate outcomes after adult acquired buried penis repair and to develop a classification system based on preoperative assessment.

METHODS

The authors reviewed data from patients who underwent buried penis reconstruction at a single institution. Patient history and physical examination guided the development of a classification system for surgical planning.

RESULTS

Of the 27 patients included, the mean age was 56 ± 15 years and mean body mass index was 49 ± 14 kg/m2. Patients were classified into 4 groups based on examination findings: (I) buried penis due to skin deficiency, iatrogenic scarring, and/or diseased penile skin (n = 3); (II) excess abdominal skin and fat (n = 6); (III) excess skin and fat with diseased penile skin (n = 16); and (IV) type III plus severe scrotal edema (n = 2). Surgical treatment (eg, excision and grafting, mons suspension, panniculectomy, translocation of testes, and/or scrotectomy) was tailored based on classification. Complications included wound breakdown (n = 3), cellulitis (n = 4), and hematoma (n = 1). Nearly all patients (96%) reported early satisfaction and improvement in their symptoms postoperatively.

CONCLUSIONS

Classifying patients with buried penis according to preoperative examination findings may guide surgical decision-making and preoperative counseling and allow for optimized aesthetics to enhance self-esteem and sexual well-being.

LEVEL OF EVIDENCE: 4

The Prevalence of Penile Cancer in Patients With Adult Acquired Buried Penis

OBJECTIVE

To determine the prevalence of penile cancer in patients with adult acquired buried penis (AABP). Penile cancer is a rare but aggressive cancer. Several case reports have recently been published that indicate that AABP may increase the risk of penile cancer.

MATERIALS AND METHODS

A retrospective review was conducted of adults diagnosed with AABP and penile cancer between January, 2008 and December, 2018 seen at a tertiary referral center. Demographics including age, BMI, comorbidities, etiology of AABP, smoking history, circumcision status, and premalignant lesions (condyloma, lichen sclerosus [LS] carcinoma in situ [CIS]) were recorded. For patients with penile cancer, AJCC staging, grade, TNM staging and treatments were recorded. Basic descriptive statistics were performed for the overall cohort. We used Chi-square tests and Fisher exact tests to compare differences between patients with benign pathology and patients with malignant or pre-malignant pathology.

RESULTS

We identified 150 patients with the diagnosis of AABP. The prevalence of penile squamous cell carcinoma was 7%. There was a 35% rate of premalignant lesions. This study is limited by its retrospective and single-institution nature.

CONCLUSION

AABP is a condition that incorporates multiple risk factors for penile cancer. The prevalence of penile cancer appears to be higher in patients with AABP; however, more data are needed to confirm these initial findings. Patients with AABP should be counseled on these risks and should be considered for buried penis repair if a physical examination cannot be performed.

Acquired Buried Penis in Adults: A Review of Surgical Management

INTRODUCTION

Acquired buried penis (ABP) is a urologic condition that has significant morbidity and negative effect on quality of life, including but not limited to sexual function, hygiene, micturition, and self-image. This disease process is characterized by a wide degree of variability and severity that requires a patient-specific approach and significant flexibility on the surgeon's behalf.

AIM

To review and present the current evaluation and surgical management of this rare and complex patient population.

METHODS

A structured review of the English language literature from 1970 to June 2018 was performed using the PubMed and MEDLINE medical databases. Queried terms included "buried penis," "concealed penis," "hidden penis," "adult buried penis," "cicatricial penis," "trapped penis," "inconspicuous penis," "scrotoplasty and obesity," "penile release," "penile skin graft," "penile reconstruction," and "pubic lift." Papers were individually reviewed for their utility and applicability to the management of adult ABP. Manuscripts focusing on pediatric patients were excluded.

MAIN OUTCOME MEASURE

Current surgical management options for adult ABP are heterogenous but focus on preserving shaft length while improving cosmesis and voiding function.

RESULTS

Surgical versatility remains critical for successful outcomes. However, recent advances in surgical techniques for correction of adult ABP focus on the use of skin grafting to cover the shaft, along with lipectomy and/or scrotoplasty to further aid penile exposure. Collaboration with multiple surgical services is often required to achieve optimal outcomes.

CONCLUSION

ABP is a complex urologic condition with equally complex surgical treatment options. Care must be taken when planning a surgical intervention, and support from plastic or general surgery may be required. However, with careful selection, surgical correction frequently leads to significant improvement in function and quality of life. Smith-Harrison LI, Piotrowski J, Machen GL, et al. Acquired Buried Penis in Adults: A Review of Surgical Management. Sex Med Rev 2020;8:150-157.

The Use of Full Thickness Skin Graft Phalloplasty During Adult Acquired Buried Penis Repair

OBJECTIVE

To evaluate the feasibility and outcomes of full thickness penile skin grafting (FTSG) for phalloplasty during acquired buried penis repair.

MATERIALS AND METHODS

A retrospective cohort study of patients undergoing complex genital reconstruction for buried penis between January 2013 and April 2018 was performed. Patients undergoing FTSG were identified. All patients underwent escutcheonectomy, scrotoplasty, and penile skin grafting by a single Urologist (MM) and Plastic surgeon (JS). Escutcheon tissue was used for the FTSG. The primary outcome was graft take and the secondary outcome was recurrence requiring surgical revision.

RESULTS

Thirteen patients were identified for inclusion in the study with average age of 43.4 and average BMI of 42. Median (range) follow-up for the cohort was 8 (3-44) months. Surgical indication was lymphedema in 6 (46.2%), morbid obesity in 6 (46.2%), and hidradenitis suppurativa in one (7.7%). Seven required concurrent urethromeatoplasty for meatal stenosis and fossa navicularis strictures. All grafts were successful. Two patients developed postoperative wound infections requiring antibiotics. One patient redeveloped lymphedema of the scrotum and required complete revision surgery although the FTSG remained intact. No patients had reburying of the penis. Minor outpatient surgical revision was performed for 2 patients for scarring and edema of the glans.

CONCLUSION

Full thickness skin grafts provide a useful option for penile reconstruction during surgical management of buried penis. Patients had excellent graft acceptance and minimal wound complications. Further research and comparative cohorts are warranted to fully determine the role of FTSG in genital reconstruction.

Prevalence and surgical management of concurrent adult acquired buried penis and urethral stricture disease

PURPOSE

To describe the prevalence and surgical management of coexistent adult acquired buried penis (AABP) and urethral stricture disease. AABP patients often have urinary dribbling with resultant chronic local moisture, infection, and inflammation that combine to cause urethral stricture disease. To date, no screening or surgical management algorithms have been described.

METHODS

A multi-institutional retrospective study was conducted of the surgical management strategies for patients with concurrent AABP and urethral stricture disease from 2010 to 2017. AABP patient demographics, physical exam findings, and comorbidities were compared between those with and without stricture disease to suggest those that would selectively benefit from screening for stricture disease.

RESULTS

Of the 42 patients surgically managed for AABP, 13 had urethral stricture disease (31.0%). Stricture location was universal in the anterior urethra. Sixty-one percent (n = 8) of strictures were 6 cm or longer and managed prior to AABP repair with Kulkarni urethroplasty. Patients with urethral stricture disease were significantly more likely to have clinically diagnosed lichen sclerosus (p = 0.00019). There was no significant difference in BMI, age, or comorbidities between patients with and without urethral stricture disease.

CONCLUSIONS

Extensive anterior urethral stricture is common in patients with AABP. Clinical characteristics cannot predict stricture presence except possibly the presence of lichen sclerosus. Definitive stricture surgical options include extensive Johanson Urethroplasty or Kulkarni Urethroplasty. Kulkarni Urethroplasty prior to AABP repair has the benefits of a single-stage repair, good cosmetic outcome with meatal voiding, and dorsal graft placement to allow safe degloving of the penis in the subsequent AABP repair.