Modified three-step procedure to treat buried penis in children without previous surgery: experience in 150 cases

[Background] The buried penis has an abnormally smaller and shorter appearance. We performed a modified three-step procedure to correct the buried penis with satisfactory cosmetic results. [Methods] From May 2014 to December 2020, 150 boys, ranging in age from 2 to 7 years old (median age: 3.3 years), underwent this three-step procedure. The chief complaint was a smaller and shorter appearance of the penis. The surgical procedure consisted of three steps: complete degloving through a diamond-shaped penoscrotal incision, circumcision to remove the majority of the inner plate, and anchoring of the penopubic skin to the base of albuginea penis at the 4 and 8 o’clock positions with unabsorbable sutures. [Results] The mean operative time was 50 minutes (range from 40 to 60 minutes). The mean follow-up time was 2.8 years (range from 10 months to 6 years). There were no complications or recurrences. Good cosmetic results were achieved in all boys. [Conclusions] Our modified three-step procedure had good cosmetic results without complications. We recommend this effective surgical procedure for boys with buried penis who have no history of previous surgery.

Treatment of the hidden penis in boys

Introduction. “Hidden penis” (HP) is a developmental malformation of the penis characterized by normally developed, but abnormally located cavernous bodies in the surrounding tissues of the symphysis or scrotum, manifested by the visually shortened penis trunk. The most common type is «buried» penis (BP). This pathology requires, as a rule, surgical treatment.Purpose. To assess outcomes of BP treatment with an improved surgical technique.Material and methods. 40 boys, aged from 2 to 16 (average age 9 ± 1.59) and diagnosed with HP, were treated in 2014-2019. BP was diagnosed in 35 children (87.5%), webbed penis (WP) – in five (12.5%). Primary BP was in 18 children (51.4%) and BP in combination with the suprapubic obesity - in 17 patients (48.6%). Two children (5%) were operated after the previous circumcision. Indications for surgery were: congenital primary HP, secondary HP in adolescents with insufficient visualization of the penis, psychological discomfort of the patient and the absence of significant clinical effects after conservative care. The average age of children with primary HP was 3.9 ± 2.48; with secondary HP and pubic obesity - 12 ± 3.84 years. During surgery, circular or circular and ventral midline incisions to the middle of the scrotum were used; they were followed by mobilization of the penis from adhesions, excision of adipose tissue in the bosom, fixation of the pubopenile and penoscrotal angles with a non-absorbable surgical thread. The authors have proposed a new technique for foreskin fixation using 2 ventral and 2 dorsal incisions, through which the skin was sutured to the deep fascia of the penis to prevent its distal slipping.Results. All patients had good anatomical and functional results. The authors describe the developed surgical technique in details; they also make literature review on the discussed problem.Conclusion. In the treatment of HP an improved surgical technique with the additional use of incisions allows you to reliably fix the skin of the foreskin on the trunk of the penis, avoiding its distal displacement.

Penile Prosthesis Placement with Immediate Buried Penis Correction: A Retrospective Chart Review

Introduction: We present a case report on six patients who underwent a combined approach to improve the cosmetic appearance and functional performance of their buried penis. Aim: To report our combined approach to improve both buried penis and erectile dysfunction. Methods: In one surgery, we performed: a malleable penile prosthesis, ventral phalloplasty, and penile suspensory ligament release followed by a suprapubic lipectomy. Results: Postoperatively, all patients had an increase in penile length and were able to achieve successful penetrative intercourse. The average difference between the pre-operational and post-operational flaccid length of our six patients was 3.5 cm ± 1.38 (range, 1.9 to 5.08 cm). Conclusion: This case series serves as successful examples of using a combined approach in one stage to not only improve the cosmetic appearance of a buried penis but also address erectile dysfunction.