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Comparison of Three Surgical Techniques for Concealed Penis in Children
Qi-Fei Deng1, Han Chu2, Yongsheng Cao2
1Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui, China; Department of Urology, Anhui Public Health Clinical Center, Hefei 230000, Anhui, China; The Second Department of Pediatric Urology Surgery, Anhui Provincial Children's Hospital, Children's Hospital of Fudan University-Anhui Campus, 230000 Hefei, Anhui, China.
Insights
Pediatric concealed penis surgery comparison shows pedicled island flap and scrotal advancement offer better outcomes. These techniques provide superior penile length preservation and fewer complications than the modified Shiraki method.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Genitourinary Surgery
Background:
- Severe concealed penis is a congenital condition requiring surgical correction in pediatric patients.
- Various surgical techniques exist, but comparative data on long-term efficacy is limited.
Purpose of the Study:
- To compare the efficacy of three distinct surgical approaches for severe concealed penis in pediatric patients.
- Evaluate operative duration, postoperative complications, and functional outcomes.
Main Methods:
- Retrospective cohort analysis of 150 pediatric patients from January 2020 to January 2023.
- Stratification into three groups: pedicled island flap (Group A), modified Shiraki inlay (Group B), and scrotal skin advancement (Group C).
- Comparative analysis of operative time, complications (scarring, infection, edema, retraction), and penile length gain at 6-month follow-up.
Main Results:
- No intraoperative neurovascular or urethral complications were observed in any group.
- Pedicled island flap (Group A) showed significantly greater penile length gain (2.8 cm) compared to modified Shiraki (Group B, 2.1 cm).
- Scrotal advancement (Group C) had shorter operative duration (82 min) than pedicled island flap (98 min), while Group A had lower retraction (2%) and edema (4%) rates than Group B (14% and 18%, respectively).
Conclusions:
- All three surgical techniques effectively correct severe concealed penis.
- Pedicled island flap reconstruction and scrotal advancement plasty demonstrate superior long-term outcomes.
- These preferred methods offer better tissue viability, phallic length preservation, and reduced complication rates compared to the modified Shiraki technique.
Objective:
To compare the efficacy of three surgical approaches for correcting severe concealed penis in pediatric patients.
Methods:
We conducted a retrospective cohort analysis of 150 consecutive cases treated at our hospital from January 2020 through January 2023. Participants were stratified into three intervention groups: Group A (pedicled island flap transfer, n = 50), Group B (modified Shiraki penile skin inlay, n = 50), and Group C (scrotal skin advancement technique, n = 50). Comparative parameters included operative duration, postoperative complications (scarring, infection, edema, and retraction), and penile shaft exposure measurements at 6-month follow-up.
Results:
All procedures were completed without intraoperative neurovascular bundle injury or urethral complications. No cases exhibited persistent postoperative preputial edema or dysphoric erection. Demographic characteristics, including mean age (4.2 ± 1.3 years), body mass index percentile (78.4 ± 12.6), and preoperative infection rates, showed no intergroup differences (P >.05). Significant variances emerged in operative duration (Group A: 98 ± 15 minutes vs Group C: 82 ± 12 minutes, P = .017), postoperative penile length gain (Group A: 2.8 ± 0.6 cm vs Group B: 2.1 ± 0.5 cm, P <.01), retraction rates (Group B: 14% vs Group A: 2%, P = .03), and persistent edema incidence (Group B: 18% vs Group A: 4%, P = .008).
Conclusion:
While all three techniques effectively addressed severe concealed penis deformity, pedicled island flap reconstruction (Group A) and scrotal advancement plasty (Group C) demonstrated superior long-term outcomes in tissue viability and complication profiles. These approaches achieved significantly better phallic length preservation and lower reoperation rates compared to the modified Shiraki technique.
