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Prevalence and surgical management of concurrent adult acquired buried penis and urethral stricture disease

  • Thomas W. Fuller
  • Kelly Pekala
  • Katherine M. Theisen
  • Alexander Tapper
  • Frank Burks
  • Paul J. Rusilko
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Adult acquired buried penis Urethral stricture Lichen sclerosus Panurethral stricture disease Kulkarni urethroplasty 

Notes

Author contributions

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.

Ethical approval

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Thomas W. Fuller
    • 1
  • Kelly Pekala
    • 1
  • Katherine M. Theisen
    • 1
  • Alexander Tapper
    • 2
  • Frank Burks
    • 2
  • Paul J. Rusilko
    • 1
  1. 1.Department of UrologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department UrologyBeaumont HospitalRoyal OakUSA

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