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Surgical Reconstruction of Buried Penis

  • Paul J. RusilkoEmail author
  • Thomas W. Fuller
  • Frank Burks
Chapter

Abstract

Entrapment of the phallus because of morbid obesity, post-circumcision cicatrix formation, genital skin loss, trauma, or genital lymphedema in the adult patient is referred to collectively as acquired buried penis or concealed penis. It is a morbid condition due to sexual dysfunction, lower urinary tract symptoms, local skin excoriation, and associated depression. Increasingly, there is a recognition that adult acquired buried penis is associated with lichen sclerosus and urethral stricture disease. Surgical management is complex and complications include penile reburying, wound breakdown, and unsatisfactory cosmetic and functional outcomes are not uncommon. Preoperative evaluation and optimization is paramount as patients with buried penis very often have comorbidities associated with obesity that affect wound healing. Despite the challenges and frequent complications, patients report significant improvements in quality of life in both urinary and sexual domains with contemporary surgical treatment. Almost universally, patients also report they would undergo surgery again when queried.

Keywords

Adult acquired buried penis Hidden penis Morbid obesity Genital lymphedema Cicatrix 

References

  1. 1.
    Maizels M, Zaontz M, Donovan J, Bushnick PN, Firlit CF. Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder. J Urol. 1986;136(1 Pt2):268–71.PubMedCrossRefGoogle Scholar
  2. 2.
    King IC, Tahir A, Ramanathan C, Siddiqui H. Buried penis: evaluation of outcomes in children and adults, modification of a unified treatment algorithm, and review of the literature. ISRN Urol. 2013;  https://doi.org/10.1155/2013/109349.CrossRefGoogle Scholar
  3. 3.
    Higuchi TT, Yamaguchi Y, Wood HM, Angermeier KW. Evaluation and treatment of adult concealed penis. Curr Urol Rep. 2012;13(4):277–84.PubMedCrossRefGoogle Scholar
  4. 4.
    Pestana IO, Greenfield JM, Walsh M, Donatucci CF, Erdmann D. Management of “buried” penis in adulthood: an overview. Plast Reconstr Surg. 2009;124(4):1186–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Tausch TJ, Tachibana I, Siegel JA, Hoxworth R, Scott JM, Morey AF. Classification system for individualized treatment of adult acquired buried penis syndrome. Plast Reconstr Surg. 2016;138(3):703–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Alwaal A, McAninch JW, Harris CR, Breyer BN. Utilities of split-thickness skin grafting for male genital reconstruction. Urology. 2015;86(4):835–9.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Boonjindasuup A, Pinsky M, Stewart C, Trost L, Chaffin A, Jansen D, Hellstrom W. Management of adult concealed penis using a meshed, split-thickness skin graft. Can Urol Assoc J. 2016;10(11–12):E407–E11.CrossRefGoogle Scholar
  8. 8.
    Asimakopoulos AD, Iorio B, Vespasiani G, Cervelli V, Spera E. Autologous split-thickness skin graft for penile coverage in the treatment of buried (trapped) penis after radical circumcision. BJU Int. 2012;110(4):602–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Stokes TH, Follmar KE, Silverstein AD, Weizer AZ, Donatucci CF, Anderson EE, Erdmann D. Use of negative-pressure dressings and Split-thickness skin grafts following penile shaft reduction and reduction scrotoplasty in the management of penoscrotal elephantiasis. Ann Plast Surg. 2006;56(6):649–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Weinfeld AB, Kelley P, Yuksel E, Tiwari P, Hsu P, Choo J, Hollier LH. Circumferential negative-pressure dressing (VAC) to bolster skin grafts in the reconstruction of the penile shaft and scrotum. Ann Plast Surg. 2005;54(2):178–83.PubMedCrossRefGoogle Scholar
  11. 11.
    Senchenkov A, Knoetgen J, Chrouser KL, Nehra A. Application of vacuum-assisted closure dressing in penile skin graft reconstruction. Urology. 2006;67(2):416–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Voznesensky MA, Lawrence WT, Keith JN, Erickson BA. Patient-reported social, psychological, and urologic outcomes after adult buried penis repair. Urology. 2017;103:240–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Hampson LA, Muncey W, Chung PH, Ma CC, Friedrich J, Wessells H, Voelzke BB. Surgical and functional outcomes following buried penis repair with limited panniculectomy and split-thickness skin graft. Urology. 2017;110:234–8.PubMedCrossRefGoogle Scholar
  14. 14.
    World Health Organization. Fact sheet: obesity and overweight. http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 8 Aug 2018.
  15. 15.
    Erickson BA, Elliott SP, Myers JB, Voelzke BB, Smith TG, et al. Understanding the relationship between chronic systemic disease and lichen sclerosus urethral strictures. J Urol. 2016;195(2):363–8.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Pariser JJ, Soto-Aviles OE, Miller B, Husainat M, Santucci RA. A simplified adult acquired buried penis repair classification system with an analysis of perioperative complications and urethral stricture disease. Urology. 2018;120:248–52.  https://doi.org/10.1016/j.urology.2018.05.029.PubMedCrossRefGoogle Scholar
  17. 17.
    Theisen KM, Fuller TW, Rusilko P. Surgical management of adult-acquired buried penis: impact on urinary and sexual quality of life outcomes. Urology. 2018;116:180–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Liaw A, Rickborn L, McClung C. Incidence of urethral stricture in patients with adult acquired buried penis. Adv Urol. 2017;2017:1–3.  https://doi.org/10.1155/2017/7056173.CrossRefGoogle Scholar
  19. 19.
    Cavayero CT, Cooper MA, Harlin SL. Adult-acquired hidden penis in obese patients: a critical survey of the literature. J Am Osteopath Assoc. 2015;115(3):150–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Alter GJ, Ehrlich RM. A new technique for correction of the hidden penis in children and adults. J Urol. 1999;161(2):455–9.PubMedCrossRefGoogle Scholar
  21. 21.
    McDougal WS. Lymphedema of the external genitalia. J Urol. 2003;170(3):711–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Garaffa G, Christopher N, Ralph DJ. The management of genital lymphoedema. BJU Int. 2008;102(4):480–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Morey AF, Meng MV, McAninch JW. Skin graft reconstruction of chronic genital lymphedema. Urology. 1997;50(3):423–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Belsante MJ, Selph JP, Peterson AC. The contemporary management of urethral strictures in men resulting from lichen sclerosus. Transl Androl Urol. 2015;4(1):22–8.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Fuller TW, Pekala K, Theisen KM, Tapper A, Burks F, Rusilko PJ. Prevalence and surgical management of concurrent adult acquired buried penis and urethral stricture disease. World J Urol. 2018;  https://doi.org/10.1007/s00345-018-2514-1.PubMedCrossRefGoogle Scholar
  26. 26.
    Tsourdi E, Barthel A, Rietzsch H, et al. Current aspects in the pathophysiology and treatment of chronic wounds in diabetes mellitus. Biomed Res Int. 2013;  https://doi.org/10.1155/2013/385641.CrossRefGoogle Scholar
  27. 27.
    Greenhalgh DG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30(1):37–45.PubMedCrossRefGoogle Scholar
  28. 28.
    McDaniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Continence Nurs. 2014;41(5):415–23.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Jun MS, Gallegos MA, Santucci RA. Contemporary management of adult-acquired buried penis. BJU Int. 2018;122:713–5.  https://doi.org/10.1111/bju.14230.PubMedCrossRefGoogle Scholar
  30. 30.
    Abdulla A, Daya D, Pinthus J, Davies T. Buried penis: an unrecognized risk factor in the development of invasive penile cancer. Can Urol Assoc J. 2012;6(5):E199–202.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Manwaring J, Vourganti S, Nikolavsky D, Valente AL, Byler T. Pannus is the new prepuce? Penile cancer in a buried phallus. Case Rep Urol. 2015;2015:1–4.  https://doi.org/10.1155/2015/403545.CrossRefGoogle Scholar
  32. 32.
    Donatucci CF, Ritter EF. Management of the buried penis in adults. J Urol. 1998;159:420–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Xu JG, Lv C, Wang YC, Zhu J, Xue CY. Management of concealed penis with modified penoplasty. Urology. 2015;85(3):698–702.PubMedCrossRefGoogle Scholar
  34. 34.
    Westerman ME, Tausch TJ, Zhao LC, Siegel JA, Starke N, et al. Ventral slit scrotal flap: a new outpatient surgical option for reconstruction of the adult buried penis syndrome. Urology. 2015;85(6):1501–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Zucchi A, Perovic S, Lazzeri M, Mearini L, Costantini E, et al. Iatrogenic trapped penis in adults: new, simple 2-stage repair. J Urol. 2010;183(3):1060–3.PubMedCrossRefGoogle Scholar
  36. 36.
    Ghanem H, ElKhaiat YI, Motawi AT, AbdelRahman IF. Infrapubic liposuction for penile length augmentation in patients with infrapubic adiposities. Aesthet Plast Surg. 2017;41(2):441–7.CrossRefGoogle Scholar
  37. 37.
    Adham ML, Teimourian B, Mosca P. Buried penis release in adults with suction lipectomy and abdominoplasty. Plast Reconstr Surg. 2000;106(4):840–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Shaeer O, Shaeer K. Revealing the buried penis in adults. J Sex Med. 2009;6(3):876–85.PubMedCrossRefGoogle Scholar
  39. 39.
    Figler BD, Chery L, Friedrich JB, Wessells H, Voelzke BB. Limited panniculectomy for adult buried penis repair. Plast Reconstr Surg. 2015;136(5):1090–2.PubMedCrossRefGoogle Scholar
  40. 40.
    Azzopardi EA, Boyce DE, Dickson WA, Azzopardi E, Laing JH, Whitaker IS, Shokrollahi K. Application of topical negative pressure (vacuum-assisted closure) to split-thickness skin grafts: a structured evidence-based review. Ann Plast Surg. 2013;70(1):23–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Iblher N, Fritsche HM, Katzenwadel A, Penna V, Eisenhardt SU, Stark GB, Lampert F. Refinements in reconstruction of penile skin loss using intra-operative prostaglandin injections, postoperative tadalafil application and negative pressure dressings. J Plast Reconstr Aesthet Surg. 2012;65(10):1377–83.PubMedCrossRefGoogle Scholar
  42. 42.
    Suh H, Lee AY, Park EJ, Hong JP. Negative pressure wound therapy on closed surgical wounds with dead space: animal study using a swine model. Ann Plast Surg. 2016;76(6):717–22.PubMedCrossRefGoogle Scholar
  43. 43.
    Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg. 2016;103(5):477–86.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Rybak J, Larsen S, Yu M, Levine LA. Single center outcomes after reconstructive surgical correction of adult acquired buried penis: measurements of erectile function, depression, and quality of life. J Sex Med. 2014;11(4):1806–91.CrossRefGoogle Scholar
  45. 45.
    Hughes DB, Perez E, Garcia RM, Aragón OR, Erdmann D. Sexual and overall quality of life improvements after surgical correction of “buried penis”. Ann Plast Surg. 2016;76(5):532–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paul J. Rusilko
    • 1
    Email author
  • Thomas W. Fuller
    • 2
  • Frank Burks
    • 3
  1. 1.Department of UrologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of UrologyUniversity of California San DiegoSan DiegoUSA
  3. 3.Beaumont Health Department of UrologyOakland University William Beaumont School of MedicineRoyal OakUSA

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