Buried Penis
Buried Penis
net/publication/248383792
New Surgical Technique for the Treatment of Buried Penis: Results and
Comparison with a Traditional Technique in 75 Patients
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to slide freely on the deeper layers and allows the penis to with surgery and by complication rate/need for redo surgery. The
stretch easily in erection. In buried penis, this tissue lacks first subjective evaluation criterion was the satisfaction of patients/
parents at the first postoperative consultation 6 weeks after surgery
elasticity and retracts the penis into the depths, since the and at the last follow-up 1 year after surgery. The second subjective
penile skin is not anchored to the deep fascia of Buck [3]. evaluation criterion was the surgeon’s satisfaction with surgery re-
In adults, the condition of buried penis is mostly acquired sults at 6 weeks and 1 year. Good outcome according to patients/
due to a loss of elasticity of the dartos tissues with age and parents was defined by satisfactory aesthetical appearance and
to a progressive accumulation of suprapubic fat. meeting of expectations. Good outcome according to the surgeon
was defined by healing without complication and if the expected
The condition of buried penis can be symptomatic outcome of the operation was reached. Bad outcome was reported
both in children and adults. Cosmetics are the most fre- if the above-mentioned criteria were not met and/or buried penis
quent motive of complaint. Recurring balanitis or void- reoccurred.
ing difficulties, urine spraying and dribbling can be asso- The outcome of both procedures was also objectively assessed
ciated with this condition [4, 5]. In infants, parents often by complication rate and need for reoperation. Reoperation rate,
type of reoperation, results of the reoperation and time between
report ballooning of phimotic penis if uncircumcised, initial procedure and reoperation were also reported. Statistical
and paediatricians who are unfamiliar with this condition analysis was performed using Fisher’s exact test comparing two
often call it micropenis. On clinical evaluation in adults groups. The local ethics committee approved this retrospective
as well as in children, the penis appears to have a normal study.
length when applying pressure on both sides of the penile
Surgical Technique
shaft base. The initial technique used consisted of a skin-sparing circumci-
Several techniques to correct penile concealment have sion as described by Boemers and De Jong [8]. The new surgical
been described in small series [1, 4, 6–18]. We describe a technique developed and used is done as follows: The patient un-
new technique and compare the results of this new tech- der general anaesthesia is placed in the supine position and pro-
nique with a classical approach we used for several years. phylactic antibiotics are given. The operative field is disinfected, a
polypropylene traction suture is placed in the glans, and a bladder
catheter is inserted. A circumcision incision is performed, further
extending longitudinally on the ventral side of the penile shaft
Patients and Methods from the circumcision incision to the cranial part of the scrotum
(fig. 1). Careful deglovement of the penis is done with release of all
Patients tethering fibrotic dartos tissue bands, until the penis is freed to its
75 patients underwent surgical repair of buried penis between base (fig. 2, 3). A dartos tissue flap is taken dorsally, as classically
1997 and 2011 in the hands of one single surgeon (P.H.). The first described in hypospadias surgery (fig. 4, 5) [19]. This flap is split
17 patients (mean age 2.6 years) underwent a classical repair con- into two equal parts and brought ventrally (fig. 6). The base of the
sisting of skin-sparing circumcision, until 2003. The surgical ap- stretched penis is anchored bilaterally at the level of the corpus
proach was changed in 2004 and the next 58 patients underwent a cavernosum with the ventrally brought dartos flap with one gly-
new surgical technique in which anchoring of the penis to dartos colic copolymer suture, which is also used for haemostasis of this
bundles at the penoscrotal angle is the key point (47 children, mean dartos bundle (fig. 7). The excessive dartos tissue is removed
age 4.4 years; 11 adults, mean age 38 years). (fig. 8). Careful haemostasis is done before closing the skin. Exces-
sive skin is removed and the penile skin is sutured to the subcoro-
Methods nal mucosa. A circumcision is often needed due to the lack of skin
The outcome of both techniques was evaluated by patients’/ with a stretched penis (fig. 9, 10).
parents’ satisfaction with surgery, by the surgeon’s satisfaction
193.191.170.2 - 7/31/2014 3:14:55 PM
Fig. 3. Release of all tethering fibrotic dar- Fig. 6. Dartos flap split dorsally. Fig. 8. Removal of excessive dartos tissue.
tos tissue.
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