Buried penis in adults as a complication of circumcision: Surgical management and long‐term outcomes

Abstract

We aimed to evaluate the feasibility and long‐term functional outcomes of surgical correction of adult buried penis patients due to complications of childhood circumcision. A retrospective analysis was performed for patients who underwent treatment for buried penis between 1997 and 2019. An autologous split‐thickness skin graft (STSG) was used. Surgical management steps included circumcision, resection of the bands between the corpora and other tissues, harvesting of STSG from femoral region and graft application. Surgical and functional outcomes were the primary end points. Thirteen patients were included with a mean age of 22.4 years and median body mass index 27. Patients had similar symptoms, including sexual dysfunction, inadequate penile length, impossible penetration and decreased quality of life. No early post‐operative complication was seen. During a median of 44‐month follow‐up, post‐operative long‐term complications were seen in 4 (30%) patients: decreased graft sensation (n = 2); graft contracture five months after surgery (n = 1); and retarded ejaculation (n = 1). Patients’ post‐operative three‐month International Index of Erectile Function (IIEF) score and sexual satisfaction score (SSS) significantly increased compared with patients’ pre‐operative scores (IIEF; 22.8 vs. 14.1, p = .03, SSS; 8.7 vs. 3.2, p < .01). Buried penis is a rare but challenging condition. Patients had excellent graft acceptance with successful functional outcomes.

What are the benefits and harms of surgical management options for adult‐acquired buried penis? A systematic review

“…1. After screening 170 records, 21 full-text studies published between 2016 and 2021 were included in the qualitative analysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. All were single-centre retrospective case series.…”

“…Three out of 10 studies used an ad hoc-created questionnaire. Author self-impression judgement was applied in most of the studies [11,13,14,15,17,19,21], while only Ghanem et al used the Likert scale [26]. Overall, a notable improvement in cosmetic function was detected.…”

“…The questionnaires used included the IIEF (five studies, most frequently in its short form, the IIEF-5), the Expanded Prostate Cancer Index Composite (EPIC; one study), the Sexual Satisfaction Scale (one study) and the Post-Bariatric Surgery Quality of Life scale (PBS-QoL; one study). Author self-impression judgement was applied in four studies [10,14,17,19], the IIEF in five studies [11,16,18,20,21] and the PBS-QoL in only one study [24]. Overall, a significant improvement in sexual function was detected.…”

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

“…There is currently no validated patient-reported outcome measure for patients undergoing AABP repair. Several studies have implemented various patient-reported questionnaires, including the International Index of Erectile Function, 4,7,9,35 the Changes in Sexual Functioning Questionnaire, 8 and the Sexual Satisfaction Scale. 35 As these are not questionnaires specific to AABP, is not clear whether the symptoms reported on these measures were directly attributable to AABP, and they may be confounded by other conditions.…”

“…Several studies have implemented various patient-reported questionnaires, including the International Index of Erectile Function, 4,7,9,35 the Changes in Sexual Functioning Questionnaire, 8 and the Sexual Satisfaction Scale. 35 As these are not questionnaires specific to AABP, is not clear whether the symptoms reported on these measures were directly attributable to AABP, and they may be confounded by other conditions. Moreover, despite the highly variable presentation of AABP, many of these questionnaires query only sexual function and do not address other functional limitations that arise as a result of this condition, including pain with ambulation, micturition difficulties, hygiene concerns, recurrent infections, and dissatisfaction with appearance.…”