Buried penis: classification surgical approach

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Genitourinary Reconstruction

Background:

• Congenital buried penis (BP) presents a complex challenge in pediatric urology.
• Accurate morphological classification is crucial for effective surgical planning.

Purpose of the Study:

• To establish a morphological classification system for congenital buried penis (BP).
• To present a versatile surgical technique for BP correction tailored to morphological grades.

Main Methods:

• A classification system was developed based on morphological findings in 61 patients.
• Patients were categorized into Grade I (Longer Inner Prepuce - LIP), Grade II (LIP with ligamentous involvement), and Grade III (LIP, ligamentous involvement, and excess suprapubic fat).
• A ventral midline penile incision was utilized, with surgical approach adjusted per grade; all patients underwent circumcision.

Main Results:

• All 61 patients exhibited abnormally long inner prepuce (LIP).
• Forty-seven patients had a short penile shaft.
• Satisfactory outcomes were achieved in 91% of patients (29/29 Grade I, 27/29 Grades II/III), with 9% requiring revision surgery.

Conclusions:

• Congenital buried penis (BP) is a spectrum condition characterized by LIP, potentially involving a short penile shaft, abnormal ligamentous attachments, and excess suprapubic fat.
• Congenital Mega Prepuce (CMP) is identified as a variant of Grade I BP.
• The described surgical approach demonstrates efficacy and versatility in managing different grades of BP.