Evaluation and management of adult acquired buried penis

Tammy S Ho, Joel Gelman, Tammy S Ho, Joel Gelman

Abstract

Adult acquired buried penis represents the clinical manifestation of a wide spectrum of pathology due to a variety of etiologies. It can be related to obesity, a laxity in connective tissue, lichen sclerosis (LS), complications from penile/scrotal enlargement surgery, scrotal lymphedema, or hidradenitis suppurativa (HS). Buried penis can be associated with poor cosmesis and hygiene, voiding dysfunction, and sexual dysfunction. Evaluation and management of buried penis largely depends on etiology and degree of affected tissue. It is an increasingly common problem seen by reconstructive urologists and here we present several frequently seen scenarios of buried penis and management options.

Keywords: Balanitis xerotica obliterans (BXO); buried penis; lichen sclerosis (LS); massive localized lymphedema (MLL).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Due to inflammation and lichen sclerosis, a phimotic band often forms, pushing the phallus proximally and burying it.
Figure 2
Figure 2
Technique to unbury the phallus while avoiding a large deficiency of dorsal skin. (A) Four relaxing longitudinal incisions are made dorsally, ventrally, and bilaterally rather than one long dorsal slit to decrease the dorsal skin defect; (B) the four longitudinal incisions are then closed transversely to more evenly distribute the penile skin loss along the circumference of the penis.
Figure 3
Figure 3
Buried penis repair after penile and scrotal enlargement surgery. (A) There is significant buried penis after injection of silicone into the penile and scrotal skin due to scarring and tissue masses; (B) relatively normal appearance of the penis immediately postoperatively after excision of scar tissue and abnormal penile and scrotal skin; (C) normal postoperative appearance of the scrotum associated with abnormal appearing penile skin tissue; (D) subsequent operation with excision of contracture penile skin with STSG; (E) appearance of the penis and scrotum several months postop. STSG, split thickness skin grafting.
Figure 4
Figure 4
Staged surgical repair of MLL of the scrotum. (A) Preoperative appearance of MLL of the scrotum; (B) T-incision marked out on the scrotum; (C) the spermatic cord and testicles are first isolated prior to removal of any lymphedematous tissue to prevent injury; (D) after the patient has healed from scrotectomy with primary closure, he is brought back into the operating room in a staged fashion to resect residual affected tissue; (E) after all remaining affected tissue is resected, STSG are placed on the penis and scrotum; (F) final cosmetic appearance after skin grafting. MLL, massive localized lymphedema; STSG, split thickness skin grafting.
Figure 5
Figure 5
Scrotal hidradenitis suppurativa with involvement of the penis, scrotum, and suprapubic skin.
Figure 6
Figure 6
STSG to the scrotum is typically meshed while STSG placed on the penis is unmeshed. STSG, split thickness skin grafting.
Figure 7
Figure 7
A left gracilis flap encompasses the testicles for added bulk and protection.

References

    1. Rybak J, Larsen S, Yu M, et al. Single center outcomes after reconstructive surgical correction of adult acquired buried penis: a measurement of erectile function, depression, and quality of life. J Sex Med 2014;11:1086-91. 10.1111/jsm.12417
    1. Alter GJ. Pubic contouring after massive weight loss in men and women: correction of hidden penis, mons ptosis, and labia major enlargement. Plast Reconstr Surg 2012;130:936-47. 10.1097/PRS.0b013e318262f57d
    1. Liu F, Lin T, He D, et al. New technique for the treatment of buried penis in children. Urology 2016;88:166-9. 10.1016/j.urology.2015.09.031
    1. Alter GJ, Ehrlich RM. A technique for correct of the hidden penis in children and adults. J Urol 1999;161:455-9. 10.1016/S0022-5347(01)61922-0
    1. Westerman ME, Tausch TJ, Zhao LC, et al. Ventral slit scrotal flap: a new outpatient surgical option for reconstruction of adult buried penis syndrome. Urology 2015;85:1501-4. 10.1016/j.urology.2015.02.030
    1. Zhao YQ, Zhang J, Yu MS, et al. Functional restoration of penis with partial defect by scrotal skin flap. J Urol 2009;182:2358-61. 10.1016/j.juro.2009.07.048
    1. Folaranmi SE, Corbett HJ, Losty PD. Does application of topical steroids for lichen sclerosis (balanitis xerotica obliterans) affect the rate of circumcision? A systematic review. J Pediatr Surg 2018. [Epub ahead of print]. 10.1016/j.jpedsurg.2017.12.021
    1. Tausch TJ, Peterson AC. Early aggressive treatment of lichen sclerosis may prevent disease progression. J Urol 2012;187:2101-5. 10.1016/j.juro.2012.01.071
    1. Koifman L, Hampl D, Koifman N, et al. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications, and late outcomes. J Urol 2013;190:2086-92. 10.1016/j.juro.2013.06.016
    1. Nelson BA, Cookson MS, Smith JA, Jr, et al. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol 2004;172:494-7. 10.1097/01.ju.0000131453.52463.8f
    1. Singh A, Jaipuria J, Goel A, et al. Comparing outcomes of robotic and open inguinal lymph node dissection in patients with carcinoma penis. J Urol 2018. [Epub ahead of print]. 10.1016/j.juro.2017.12.061
    1. Lim KH, Speare R, Thomas G, et al. Surgical treatment of genital manifestations of lymphatic filariasis: A systematic review. World J Surg 2015;39:2885-99. 10.1007/s00268-015-3220-4
    1. Singh V, Sinha RJ, Sankhwar SN, et al. Reconstructive surgery for penoscrotal filarial lymphedema: a decade of experience and follow-up. Urology 2011;77:1228-31. 10.1016/j.urology.2010.10.026
    1. Salako AA, Olanbanji JK, Oladele AO, et al. Surgical reconstruction of giant penoscrotal lymphedema in Sub-Saharan Africa. Urology 2018;112:181-5. 10.1016/j.urology.2016.09.064
    1. Machol JA, 4th, Langenstroer P, Sanger JR. Surgical reduction of scrotal massive localized lymphedema (MLL) in obesity. J Plast Reconstr Aesthet Surg 2014;67:1719-25. 10.1016/j.bjps.2014.07.031
    1. Torio-Padron N, Stark GB, Foldi E, et al. Treatment of male genital lymphedema: An integrated concept. J Plast Reconstr Aesthet Surg 2015;68:262-8. 10.1016/j.bjps.2014.10.003
    1. Wisenbaugh E, Moskowitz D, Gelman J. Reconstruction of massive localized lymphedema of the scrotum: Results, complications, and quality of life improvement. Urology 2018;112:176-80. 10.1016/j.urology.2016.09.063
    1. Voznesensky MA, Lawrence WT, Keither JN, et al. Patient-reported social, psychological, and urologic outcomes after adult buried penis repair. Urology 2017;103:240-4. 10.1016/j.urology.2016.12.043
    1. Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol 2013;133:97-103. 10.1038/jid.2012.255
    1. Rompel R, Petres J. Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 2000;26:638-43. 10.1046/j.1524-4725.2000.00043.x
    1. Büyükaşik O, Hasdemir AO, Kahramansoy N, et al. Surgical approach to extensive hidradenitis suppurativa. Dermatol Surg 2011;37:835-42.
    1. Mehdizadeh A, Hazen PG, Bechara FB, et al. Recurrence of hidradenitis suppurative after surgical management: a systematic review and meta-analysis. J Am Acad Dermatol 2015;73:S70-7. 10.1016/j.jaad.2015.07.044

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit