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Thornton SM, Seitz AJ, Eftekari SC, Grimes MD, Williams DH, Poore SO. Letter to the Editor in response to: "Surgical management of acquired buried penis and scrotal lymphedema: A retrospective review". J Plast Reconstr Aesthet Surg 2024; 95:33-34. [PMID: 38870672 DOI: 10.1016/j.bjps.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Sarah M Thornton
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Allison J Seitz
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Sahand C Eftekari
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Matthew D Grimes
- Department of Urology, University of Wisconsin, Madison, WI, United States
| | - Daniel H Williams
- Department of Urology, University of Wisconsin, Madison, WI, United States
| | - Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States.
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2
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Tekin B, Cubilla AL, Cheville JC, Smith CY, Jenkins SM, Dasari S, Enninga EAL, Norgan AP, Menon S, Whaley RD, Hernandez LH, Jimenez RE, Garcia JJ, Thompson RH, Leibovich BC, Karnes RJ, Boorjian SA, Pagliaro LC, Erickson LA, Guo R, Gupta S. High-risk human papilloma virus status & outcomes for penile squamous cell carcinoma: A single institution experience. Hum Pathol 2024; 150:9-19. [PMID: 38909709 DOI: 10.1016/j.humpath.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES There is a paucity of data on North American cohorts of patients with penile squamous cell carcinoma (pSCC). Herein, we aimed to assess the sensitivity of various modalities to identify human papillomavirus (HPV) status, determine the prevalence of high-risk HPV-positivity, and evaluate the prognostic impact of relevant clinicopathologic variables. METHODS Patients with pSCC (n = 121) consecutively treated with partial/total penectomy (2000-2022) at a single institution were included. HPV status (based on immunohistochemistry [IHC], in situ hybridization [ISH], and panviral metagenomic sequencing [PMS]), histologic features, and outcomes were reviewed. Outcome events included death due to disease and progression. RESULTS The majority of patients were white (105/121, 86.8%). Thirty-seven (30.6%) were high-risk HPV-positive, and morphologic evaluation had a sensitivity of 97.3% (95% confidence interval [CI], 86.2-99.5) for predicting high-risk HPV status compared to IHC/ISH/PMS. Disease progression was more common among high-risk HPV-negative compared to high-risk HPV-positive patients (HR 2.74, CI 1.12-8.23, P = 0.03). Moreover, among high-risk HPV-negative patients, those with moderate-poorly differentiated tumors had increased disease-specific mortality (32.6%, CI 17.1-48.1) compared to those with well-differentiated tumors (0%). Among high-risk HPV-positive patients, those with basaloid morphology had lower disease-specific mortality (0% vs 14.4%, CI 0.0-33.1). CONCLUSIONS We demonstrate high-risk HPV-positivity in approximately one-third of patients with pSCC. Morphologic evaluation alone had a high sensitivity in correctly determining HPV status. Our results suggest that high-risk HPV status and morphologic features (differentiation in high-risk HPV-negative, and basaloid subtype in high-risk HPV-positive pSCC) may have prognostic value.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MM, USA.
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MM, USA.
| | - Surendra Dasari
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | | | - Andrew P Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Lance C Pagliaro
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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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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4
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Gül M, Plamadeala N, Falcone M, Preto M, Cirigliano L, Peretti F, Ferro I, Scavone M, Gontero P. 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. Int J Impot Res 2024:10.1038/s41443-024-00832-7. [PMID: 38326548 DOI: 10.1038/s41443-024-00832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/17/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
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.
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Affiliation(s)
- Murat Gül
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Natalia Plamadeala
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Falcone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy.
- Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Turin, Italy.
| | - Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Cirigliano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Federica Peretti
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Ilaria Ferro
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Martina Scavone
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
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Falcone M, Preto M, Timpano M, Oderda M, Plamadeala N, Cirigliano L, Blecher G, Peretti F, Ferro I, Gontero P. The outcomes of surgical management options for adult acquired buried penis. Int J Impot Res 2023; 35:712-719. [PMID: 36400942 DOI: 10.1038/s41443-022-00642-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Marco Falcone
- Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Turin, Italy.
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy.
| | - Mirko Preto
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Massimiliano Timpano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Oderda
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Natalia Plamadeala
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Cirigliano
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Department of Urology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Federica Peretti
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Ilaria Ferro
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic - A.O.U. "Città della Salute e della Scienza" - Molinette Hospital, University of Turin, Turin, Italy
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Byard RW. Manifestations and etiology of cutaneous findings in cases of morbid obesity. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00721-3. [PMID: 37889417 DOI: 10.1007/s12024-023-00721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
Morbid obesity is associated with a wide range of metabolic, infective, and organic disorders related to adipose tissue overload. While careful documentation of internal autopsy findings is usual, skin manifestations may be overlooked. Skin manifestations are quite diverse and include striae distensae, skin tags, plantar hyperkeratosis, acanthosis nigricans, the sequelae of hyperandrogenism, lymphedema, panniculus morbidus, chronic venous insufficiency, stasis dermatitis, leg ulceration, intertrigo, cellulitis, pressure ulcers and 'buried penis'. Obesity has also been associated with hidradenitis suppurativa, psoriasis, atopic dermatitis, melanoma, systemic lupus erythematosus, lichen planus and acne vulgaris. Evaluating these findings at the time of autopsy may give a more complete assessment of a particular case and may also identify conditions that may have contributed to, or caused, death.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and the School of Biomedicine, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Frome Road, Adelaide, SA, 5000, Australia.
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Schlaepfer CH, Flynn KJ, Alsikafi NF, Breyer BN, Broghammer JA, Buckley JC, Elliott SP, Myers JB, Vanni AJ, Voelzke BB, Zhao LC, Erickson BA. Clinical Validation of an Adult-acquired Buried Penis Classification System Based on Standardized Evaluation of the Penis, Abdomen, and Scrotum. Urology 2023; 180:249-256. [PMID: 37507025 DOI: 10.1016/j.urology.2023.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/09/2023] [Accepted: 04/25/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE To clinically validate a previously developed adult-acquired buried penis (AABP) classification system that is based on a standardized preoperative physical examination that subtypes patients by their penile skin/escutcheon complex (P), abdominal pannus (A), and scrotal skin (S). METHODS The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) database was used to create an AABP cohort. Patients were retrospectively classified using the previously described PAS classification system. The frequency of subtypes, surgical methods utilized for AABP repair, and correlations between PAS classification and surgery subtypes were analyzed. RESULTS The final cohort consisted of 101 patients from 10 institutions. Interrater reliability between two reviewers was excellent (κ = 0.95). The most common subtypes were P2c (contributory escutcheon+insufficient penile skin; 27%) and P2a (contributory escutcheon+sufficient penile skin; 21%) for penile subtypes, A0 (no pannus; 41%) and A1 (noncontributory pannus; 39%) for abdominal subtypes, and S0 (normal scrotal skin with preserved scrotal sulcus; 71%) for scrotal subtypes. AABP repair procedures included escutcheonectomy (n = 59, 55%), scrotoplasty (n = 51, 48%), split-thickness skin grafting (n = 50, 47%), penile skin excision (n = 47, 44%) and panniculectomy (n = 7, 7%). P, A, and S subtypes were strongly associated with specific AABP surgical techniques. CONCLUSION The PAS classification schema adequately describes AABP heterogeneity, is reproducible among observers, and correlates well with AABP surgery types. Future work will focus on how PAS subtypes affect both surgical and patient-centered outcomes.
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Staniorski C, Grajales V, Pekala KR, Zhu X, Morrill C, Toussi A, Rusilko PJ. Buried Penis Reconstruction in the Management of Localized Penile Cancer. Urology 2022; 170:221-225. [DOI: 10.1016/j.urology.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
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9
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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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10
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Byard RW, Tan L. Buried penis and morbid obesity. Forensic Sci Med Pathol 2022; 18:205-208. [PMID: 35195846 PMCID: PMC9106619 DOI: 10.1007/s12024-022-00461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Three morbidly obese men aged 69, 49 and 45 years with respective BMIs of 46.3, 49.1 and 59.3 died suddenly from underlying cardiovascular disease. At autopsy all were found to have marked penile shortening typical of an entity known as “buried penis.” This condition arises in adulthood most commonly from morbid obesity as the penile shaft becomes enveloped by encroaching suprapubic adipose tissue. It is associated with infective, obstructive and malignant complications. Histology will be required to identify less-common causative conditions or any inflammatory or premalignant/malignant changes.
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Affiliation(s)
- Roger W Byard
- Adelaide Medical School, The University of Adelaide, Frome Road, Adelaide, 5005, Australia. .,Forensic Science South Australia, 21 Divett Place, Adelaide, South Australia, 5005, Australia.
| | - Luzern Tan
- Adelaide Medical School, The University of Adelaide, Frome Road, Adelaide, 5005, Australia
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11
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Staniorski CJ, Rusilko PJ. The concealed morbidity of buried penis: a narrative review of our progress in understanding adult-acquired buried penis as a surgical condition. Transl Androl Urol 2021; 10:2536-2543. [PMID: 34295741 PMCID: PMC8261441 DOI: 10.21037/tau-20-1232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
| | - Paul J Rusilko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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12
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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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13
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Stephen JR, Burks FN. Buried penis repair: tips and tricks. Int Braz J Urol 2020; 46:519-522. [PMID: 32167731 PMCID: PMC7239301 DOI: 10.1590/s1677-5538.ibju.2020.99.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/05/2020] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Jacob Robert Stephen
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, 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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