Outcome of surgical management of concealed penis
Mahmood Abbas1, Agnes Liard, Frederick Elbaz
1Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain. masghar48@yahoo.com
Insights
Surgical correction for concealed penis improves cosmetic and functional outcomes. While early complications are low, some patients require secondary procedures for optimal cosmetic results, with older boys showing higher satisfaction.
Area of Science:
- Urology
- Pediatric Surgery
- Plastic Surgery
Background:
- Concealed penis is a congenital anomaly presenting with cosmetic, voiding, and psychosocial concerns.
- Common contributing anatomical defects include fibrotic dartos fascia, prominent prepubic fat pad, and postoperative phimosis.
Purpose of the Study:
- To review the etiological factors, clinical presentations, and surgical outcomes for concealed penis.
- To evaluate the efficacy of a specific surgical technique for correcting concealed penis.
Main Methods:
- Retrospective review of 30 consecutive patients treated between 2000-2004.
- Patients underwent penoplasty alone or with prepubic fat pad liposuction.
- Mean follow-up was 28 months, with clinical assessment and patient interviews.
Main Results:
- Cosmetic, voiding, and psychosocial issues were primary concerns.
- High prevalence of fibrotic dartos fascia (93%) and prominent prepubic fat pad (40%) noted.
- Good cosmetic and functional results observed, with higher satisfaction in older patients; 46.6% required secondary procedures.
Conclusions:
- The surgical technique effectively addresses concealed penis, yielding good cosmetic and functional results.
- Older patients report greater satisfaction with the surgical outcomes.
- A notable rate of secondary procedures is required for optimal cosmetic enhancement.
Objective:
To review the etiological factors, clinical presentations and outcome of our surgical technique to correct the anomaly of concealed penis.
Patients And Methods:
Thirty consecutive patients were treated in 2000-2004. Mean age at operation was 6.7 years (range 13 months-15.4 years). They underwent penoplasty alone (22 patients) or penoplasty with liposuction of prominent prepubic fat pad (eight patients). The medical records of all the patients were retrospectively reviewed, and 23 patients were interviewed, examined clinically and questioned about their initial complaint and the results of our technique. Mean follow up was 28 months (range 6 months-5 years).
Results:
The patients most commonly presented with cosmetic (60.0%), voiding (56.6%) and psychosocial (50.5%) concerns. Three underlying anatomic defects contributing to concealment were observed: fibrotic dartos fascia with poor skin attachment at the base of the penis (93%), prominent prepubic fat pad (40%) and postoperative phimosis leading to trapped penis (26%). Early postoperative complications occurred in 4 patients (13.3%) and all were treated conservatively and successfully. Fourteen patients (46.6%) underwent secondary minor day-case operations, the majority for excision of redundant subcoronal preputial collar. Clinical examination of 23 patients showed very good results in terms of general appearance and accessibility. The older boys were generally more satisfied with the results of surgery than the parents of younger children, whose main source of dissatisfaction was the final circumcised appearance of the penis.
Conclusion:
The surgical approach used to correct concealed penis alleviates the initial complaint and provides good cosmetic and functional results with greater satisfaction in older patients. Our technique had a low early complication rate but a significant number of patients needed a secondary procedure to improve the final cosmetic results.
