Prevalence and surgical management of concurrent adult acquired buried penis and urethral stricture disease
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To describe the prevalence and surgical management of coexistent adult acquired buried penis (AABP) and urethral stricture disease. AABP patients often have urinary dribbling with resultant chronic local moisture, infection, and inflammation that combine to cause urethral stricture disease. To date, no screening or surgical management algorithms have been described.
A multi-institutional retrospective study was conducted of the surgical management strategies for patients with concurrent AABP and urethral stricture disease from 2010 to 2017. AABP patient demographics, physical exam findings, and comorbidities were compared between those with and without stricture disease to suggest those that would selectively benefit from screening for stricture disease.
Of the 42 patients surgically managed for AABP, 13 had urethral stricture disease (31.0%). Stricture location was universal in the anterior urethra. Sixty-one percent (n = 8) of strictures were 6 cm or longer and managed prior to AABP repair with Kulkarni urethroplasty. Patients with urethral stricture disease were significantly more likely to have clinically diagnosed lichen sclerosus (p = 0.00019). There was no significant difference in BMI, age, or comorbidities between patients with and without urethral stricture disease.
Extensive anterior urethral stricture is common in patients with AABP. Clinical characteristics cannot predict stricture presence except possibly the presence of lichen sclerosus. Definitive stricture surgical options include extensive Johanson Urethroplasty or Kulkarni Urethroplasty. Kulkarni Urethroplasty prior to AABP repair has the benefits of a single-stage repair, good cosmetic outcome with meatal voiding, and dorsal graft placement to allow safe degloving of the penis in the subsequent AABP repair.
KeywordsAdult acquired buried penis Urethral stricture Lichen sclerosus Panurethral stricture disease Kulkarni urethroplasty
TWF: project development, data analysis, and manuscript writing. KP: manuscript writing/editing and data collection. KMT: data collection. AT: data collection. FB: project development. PJR: project development
Compliance with ethical standards
Conflict of interest
The authors state they have no financial or other conflicts of interest to disclose.
This retrospective study underwent multi-institutional IRB approval and involved minimal risk to the subjects. Care was taken to protect patients’ health information and confidentiality of collected data. For this type of study formal consent is not required.
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