Acquired Buried Penis Reconstruction: A Description of the "Manta Ray" Technique and a Comparative Retrospective...

Adult acquired buried penis (AABP) is a condition in which the penis is obscured by excessive surrounding soft tissue or skin folds, commonly associated with obesity. It is often worsened by Balanitis Xerotica Obliterans or Lichen Sclerosus. It is a risk factor for penile cancer and affects self-image and mental well-being of the patient. There is limited literature comparing techniques and surgical outcomes for AABP. This retrospective cohort analysis included 46 patients, comparing "Manta Ray" (MR) versus the Elliptical Excision (EE) technique. Herein, we also describe the surgical approach of the "Manta Ray." Multivariable analysis demonstrated no significant association between surgical technique and postoperative complications. In a separate adjusted model, patients with prior weight loss had lower odds for wound dehiscence when controlling for surgical technique and BMI; however, this did not reach statistical significance. Reoperation rates were 31.8% in the EE group and 16.7% in the MR group ( P =0.307). Age at the time of surgery and diabetes mellitus were not significantly associated with postoperative complications. Operative time was significantly shorter in the MR group compared with the EE group (mean 150.7 vs. 207.4 min, P =0.0018). Buried penis recurrence was infrequent in the analysis, and not significantly different between groups (EE: 13.6% vs. MR: 4.2%, P =0.336). In conclusion, the Manta Ray technique provides an aesthetic multivector exposure of the penis, with a safety and complication profile comparable to the standard EE approach, and a significantly shorter operative time.