Penoplasty for buried penis secondary to "radical" circumcision

An unusual complication of neonatal circumcision occurs when skin from the penile shaft is excised along with the prepuce. Upon healing of the wound, the penis gets buried in the scrotum. Repair is complicated by the lack of available skin to cover the shaft of the penis. We describe a surgical technique for correction of this condition.     

成人隐匿型阴茎误行包皮环切术后矫正手术效果分析

目的探讨隐匿型阴茎的成年男性患者误行包皮环切术后矫正手术的效果。方法2007年至2012年共收治误行包皮环切术的成人隐匿阴茎患者19例,年龄19～27岁,平均（22±2．6）岁。所有患者均存在阴茎显露不良及勃起时阴茎皮肤牵拉不适感,而其中5例伴有明显勃起痛或性交疼痛,13例体型肥胖并伴有耻骨上脂肪堆积。所有手术在全麻或硬膜麻醉下进行。采取原包皮环切切口,将阴茎皮肤完全脱套,切断异常的纤维条索带;然后显露阴茎悬韧带,将全部浅悬韧带及部分深悬韧带切断;在阴茎根部将阴茎白膜与皮下固定以防止阴茎体回缩;采用自体中厚皮片游离移植修复阴茎皮肤缺损。对于伴有耻骨上脂肪堆积的患者,先行去除脂肪：结果所有患者手术顺利,术前及术后静止状态下阴茎长度分别为（2．3±1．5）cm和（5．8±1．2）cm（P〈0．05）。术中补充的皮肤面积为25-65cm^2,平均为（42．6±12．2）cm^2。有2例患者出现移植皮片局限性坏死,经过加强换药后痊愈。所有患者对于术后效果均感满意,阴茎外露明显,无勃起时牵拉感、勃起痛或者性交疼痛发生。鳍论成人隐匿型阴茎容易被误诊为包皮过长而行包皮环切术,导致术后包皮短缩。对于误行包皮环切的阴茎患者,我们首先解除限制阴茎外露的因素,后应用自体皮片游离移植补充短缺的皮肤组织,可以从根本上解决问题,术后效果满意。     

The Ventral V-plasty: a simple procedure for the reconstruction of a congenital megaprepuce

A buried penis secondary to a megaprepuce is defined clinically by a phimosis, failure of the corporal bodies to inhabit a variably deficient penile shaft skin and a basal hemispheric ballooning of the penis during micturition. Anatomically, it describes a condition in which a normal phallus is trapped within normal prepubic connective tissue by the excessive skin of a megaprepuce and a variable abundance of dartos fascia. Many surgical procedures have been described to correct this deformity, suggesting that no single method has a clear advantage. Most of them rely on relatively complex skin flaps or on the abnormal megapreputial tissue for reconstruction of the deficient ventral shaft skin. Herein, the authors describe an alternative technique for ventral skin coverage, the Ventral V-plasty. This surgical procedure allowed for the favorable reconstruction of 10 consecutive children with a buried penis secondary to a megaprepuce. This technique is distinguished by its simplicity and consistent, pleasing cosmetic results.     

儿童隐匿阴茎的诊断与治疗

目的:提高对隐匿阴茎的认识和临床治疗效果.方法:总结62例儿童隐匿阴茎的临床资料,根据临床表现将其分为轻、中、重三型,采用改良的手术方法进行治疗.结果:术后随访1个月～3年,11例近期内出现较明显的包皮水肿,3例术后包皮过多,其余患者外观满意,无需再次手术.结论:隐匿阴茎是较为常见的先天畸形,宜行保留阴茎皮肤的整形手术,忌行单纯包皮环切术.     

Buried penis: Classification surgical approach

Purpose

The purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction.

Materials and Methods

Sixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1—29 patients with Longer Inner Prepuce (LIP) only, Grade II—20 patients who presented with LIP associated with indrawn penis that required division of the fundiform and suspensory ligaments, and Grade III—12 patients who had in addition to the above, excess supra-pubic fat.

Operative Approach

A ventral midline penile incision extending from the tip of prepuce down to the penoscrotal junction was used in all patients. The operation was tailored according to the BP Grade. All patients underwent circumcision. Mean follow up was 3 years (range 1 to 10).

Results

All 61 patients had an abnormally long inner prepuce (LIP). Forty-seven patients had a short penile shaft. Early improvement was noted in all cases. Satisfactory results were achieved in all 29 patients in grade I and in 27 patients in grades II and III. Five children (Grades II and III) required further surgery (9%).

Conclusions

Congenital buried penis is a spectrum characterized by LIP and may include in addition; short penile shaft, abnormal attachment of fundiform, and suspensory ligaments and excess supra-pubic fat. Congenital Mega Prepuce (CMP) is a variant of Grade I BP, with LIP characterized by intermittent ballooning of the genital area.     

Six years follow-up of a penis replantation in a child

Total amputation of the penis is very rare in a child. This article presents a case of a traumatic penile amputation at the base of the perineum, with scissors, in a 4-year-old child. Six hours after the aggression, the penis was replanted. Three weeks after the intervention, except for skin necrosis, the results were excellent. Six years afterward, this child has done very well from pediatric, psychological, urological, and plastic surgery points of view. Sensibility and erections are present and normal. Longer follow-ups particularly during puberty are necessary. Total amputation of the penis is a very rare accident in a child. Partial lesions are more common, particularly during circumcision. As in adult cases, replantation of the penis in a child needs a clean section by scissors or a knife, a correct conservation of the penis (in ice but without direct contact), and a short period between the lesion and the surgical procedure. All these conditions explain that very few cases are reported in the literature. We present a case of amputation of the penis in a 4-year-old child, with good results 6 years afterward.     

脱套式阴茎固定术治疗隐匿阴茎(附200例报告)

目的：探讨脱套式阴茎固定术对200例隐匿阴茎患儿的治疗效果。方法：对200例隐匿阴茎患儿采用脱套式阴茎固定术,患者平均年龄6．5岁（3～12岁）。其中并发有包茎的患儿160例,明显肥胖者20例。结果：在平均约10个月的随访中,无明显肥胖者术后阴茎外形及发育良好。20例明显肥胖者中有4例术后2～3个月左右出现轻度阴茎回缩,其余阴茎外形良好,无复发。结论：脱套式阴茎固定术是治疗隐匿阴茎的理想术式,术后并发症少,外观满意。     

经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎

目的:探寻治疗小儿埋藏阴茎的简单、有效手术方法。方法:根据埋藏阴茎的临床特点,设计一种新的手术方式即经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术:阴茎根部腹侧"V"形切口,环形松解阴茎浅、深筋膜及异常附着的肉膜肌、纤维索带,阴茎根部左、右侧白膜分别与胸膝位耻骨结节前筋膜的1、11点各缝合固定1针进行手术,共治疗小儿埋藏阴茎38例,术后随访2~6个月。结果:38例出院时阴茎外观形态均满意,阴茎体完全显露。术后随访期间35例(92.1%)阴茎外观形态满意,2例仍有阴茎轻度埋藏,1例出现包皮口瘢痕狭窄。结论:采用经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎是一简单、有效的手术方法,具有推广应用价值,但仍需积累更多的病例和更长时间的随访。     

隐匿性阴茎误诊误治后的矫治

目的:探讨隐匿性阴茎被误诊为包皮过长并行包皮环切术后的有效补救手术方法。方法:对21例隐匿性阴茎被误诊为包皮过长并行包皮环切术后的患者,采用改良的Devi ne术式矫治隐匿性阴茎和阴囊中隔带蒂皮瓣修复阴茎的皮肤缺损,观察其疗效。结果:21例患者阴茎外观均获恢复或接近正常,无一例出现皮瓣坏死,其中2例出现阴茎水肿,3月后恢复正常。随访1～2年无一例阴茎回缩,排尿勃起功能正常。结论:隐匿性阴茎误诊为包皮过长行包皮环切后,用改良的Devi ne术式治疗隐匿性阴茎和阴囊中隔带蒂皮瓣修复阴茎皮肤缺损是一种较好的手术补救方法。     

Surgical treatment of the “buried” penis

The "buried penis" occurs in a spectrum which varies from slight with only ventral webbing to almost complete burying of the penis dorsally in the prepubic fat pad and ventrally in the scrotum. From 1979 to 1985, the author operated on 80 children with these problems. Indications for surgery varied from unsatisfactory appearance of the penis before or after circumcision to almost complete concealment of the penis. Satisfactory cosmetic and functional results were achieved in most cases utilizing several surgical principles. The limitations of these procedures and their possible complications are described.     

Severe ischemia of the glans penis following circumcision: A successful treatment via pentoxifylline

Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.     

Foreskin and penile problems in childhood

Congenital penile abnormalities are common and merit paediatric surgical or urological review. These include hypospadias, congenital mega-prepuce, buried penis and epispadias. The features and management of these conditions are outlined in this article.     

隐匿型阴茎的手术治疗

目的探讨隐匿型阴茎外科治疗原则。方法回顾分析2002年3月-2005年9月本院收治的73例隐匿型阴茎患者，年龄1岁3个月-20岁，平均4岁8个月，根据患者是否合并肥胖和包茎，将其分为A、B和C三组。A组37例，为肥胖合并包茎的隐匿阴茎，采用手术Ⅰ式治疗。B组26例，体重正常，伴有或不伴有包茎的患儿，采用手术Ⅱ式治疗。C组10例为肥胖不合并包茎的患儿，可等待观察，如青春期后未能自行缓解，采用手术Ⅰ式治疗。结果术后随访3-6个月，各组阴茎显露均满意，其中B组中6例发生较重的阴茎包皮水肿，术后3个月恢复正常。结论隐匿型阴茎手术治疗方式多样化，根据不同情况选择不同的手术方式及手术时机是提高手术疗效的关键。     

Complications of a buried penis in an extremely obese patient

The buried penis syndrome in adults is a rare condition of different aetiologies. Today extreme obesity is considered as a major contributor. We present a case of a 30-year-old extremely obese patient (BMI 65 kg/m(2)) with purulent infection of the penile cavity, a phlegmon of the mons pubis and urinary retention due to a buried penis. Whereas acute complications of a buried penis in obese patients include local infection and urinary retention, chronic problems are undirected voiding, disturbed vaginal penetration and erectile dysfunction. Even though several surgical techniques are described, weight reduction should be primarily preferred.     

小儿隐匿性阴茎的诊断与外科治疗(附60例报告)

目的提高对隐匿性阴茎的诊断和外科治疗水平。方法51例患儿通过手术切除阴茎肉膜纤维索,耻骨前脂肪堆积明显的患儿同时切除了脂肪垫,严重的患儿切断阴茎悬韧带,最后将阴茎根部白膜固定于耻骨筋膜上,9例单纯肥胖患儿行包皮口纵切横缝显露阴茎头、耻骨前脂肪垫切除加阴茎根部白膜固定术。4例曾行包皮环切术和3例阴茎皮肤不足的患儿行阴囊带蒂皮瓣转移术。阴茎海绵体发育欠佳者术后辅以人绒毛膜促性腺激素治疗。结果55例患儿术后即获满意效果(91．7%)。随访2个月～5年,无明显并发症。2例患儿因固定阴茎根部白膜的缝合线开脱而复发,再次手术后治愈；3例阴茎海绵体发育欠佳者辅以人绒毛膜促性腺激素治疗后亦获满意疗效。手术有效率为95．0%。结论根据隐匿性阴茎的病理特点和严重程度,选择合理的手术方式,可明显延长阴茎的长度,而且改善了排尿症状和阴茎外观。     

Circumcision in 'buried penis'--a cautionary tale

BACKGROUND: The aim of a circumcision is to remove sufficient foreskin from the penile shaft and preputial epithelium to uncover the glans. Removal of too much preputial skin may lead to an unsatisfactory cosmetic and functional result. Patients with a congenital anomaly known as 'buried penis' are particularly susceptible to this. In this condition, abnormal dartos fascial bands or muscle fibres tether the penile shaft and as a result conceal its true length. CASE REPORT: A 5-year-old boy underwent circumcision but his 'buried penis' was not recognised by the surgeon pre-operatively. Unfortunately, his penile shaft was left almost entirely denuded of skin as a result. The wound required a full thickness graft. Follow-up at 1 year has so far been satisfactory. CONCLUSIONS: This case highlights the importance of early recognition of a buried penis when considering circumcision. It demonstrates the abnormal anatomy of a buried penis and its management. It also provides a potential reconstructive option in cases of excess skin removal.     

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

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.     

隐匿型阴茎的手术治疗(附63例报告)

目的 :探讨隐匿型阴茎的外科治疗原则。　方法 :回顾性分析 1999年 1月～ 2 0 0 2年 12月我院收治的 6 3例隐匿型阴茎患者 ,年龄 1岁 6个月～ 19岁 ,平均 7岁 2个月。根据患者是否合并肥胖与阴茎发育不良而将其分为A和B两组。A组 37例 ,为肥胖合并阴茎发育不良者 ,采用手术 Ⅰ式治疗 ;B组 2 6例 ,采用手术 Ⅱ式治疗。　结果 :术后随访 6个月 ,A组 37例阴茎显露均满意 ,7例发生较重的阴茎包皮水肿 ,3例出现耻骨联合下切口脂肪液化 ,3例耻骨联合下切口凹陷恢复不满意 ,1例出现龟头片状麻木感 ;B组 2 6例中 ,1例术后 7d阴茎回缩 ,余各例阴茎显露满意 ,包皮无明显水肿。　结论 :隐匿型阴茎手术治疗方式多样化 ,阴茎根部被膜的复位与固定是提高手术疗效的关键 ,其自然病程和手术时机有待进一步研究。     

小儿阴茎显露不良的诊治进展

小儿阴茎显露不良是由先天性发育异常使阴茎体不能正常显露的一组症状群,而不是单纯的一种疾病。主要包括埋藏阴茎、隐匿阴茎、蹼状阴茎、陷没阴茎等。而由尿道下裂、两性畸形等引起的畸形小阴茎和由内分泌异常引起的小阴茎不属于该范畴。隐匿阴茎、埋藏阴茎和蹼状阴茎的病因和病理改变是先天性的,而陷没阴茎则是后天性原因引起。根据各自的病因病理改变和临床表现,诊断并不困难。根据它们不同的类型、年龄指征和病变程度选择相应的手术方式,会取得好的疗效。     

连续Z形皮瓣在阴茎延长术中的应用

目的:提供一种阴茎延长术中创面修复方法,即连续Z形皮瓣。方法:5例患者年龄为16～34(22.4±7.2)岁,有3例有既往手术史,分别为尿道下裂行尿道成形术、"包茎"行包皮环切术、隐匿型阴茎行阴茎松解术。采用连续Z形皮瓣行阴茎延长术,解剖并切断阴茎浅悬韧带和部分深悬韧带,皮瓣依次交叉对位,无张力下缝合。根据创面渗出液多少决定是否放置引流。插尿管1～2d,阴茎适当加压包扎,术后8～10d拆线。结果:该5例患者术前阴茎勃起长度为4.0～5.8(4.8±0.8)cm,术后为7.8～9.2(8.4±0.6)cm,有2个中学生术后性格变得开朗,自信心明显增强。切口均一期愈合,术后电话随访12～48(22.8±14.9)个月,无阴茎回缩,患者及家属基本满意。结论:对于伴有外生殖器畸形、既往手术后瘢痕、包皮环切手术后的患者,连续Z形切口与传统的倒V形、M形、Z形切口相比,能获得更长的延长距离,解决了皮瓣过紧甚至无法覆盖创面的难题,减少了术后并发症的发生。