New England Section of the American Urological Association

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Characteristics and Clinical Outcomes of an Observational Patient Cohort Who Underwent Buried Penis Repair
Jaime A. Cavallo, MD, MPHS1, Daniele Abela, BS2, Rafael D. Tua-Caraccia, BA2, Elizabeth J. Pagura, BA3, Alex J. Vanni, MD1
1Lahey Hospital and Medical Center, Burlington, MA, 2Tufts University School of Medicine, Boston, MA, 3Tufts University, Medford, MA

Background:
Acquired buried penis (ABP) incurs significant health consequences including obstructive voiding, sexual dysfunction, and recurrent soft tissue and urinary tract infections. A paucity of data exists about the ABP population that pursues definitive treatment with buried penis repair (BPR). Our objective was to review the preoperative and intraoperative clinical variables and the postoperative outcomes of ABP patients who elect to undergo BPR.
Methods:
The institutional database of a single reconstructive urologist was retrospectively reviewed for ABP patients who underwent BPR between 7/2011 and 12/2018. We reviewed preoperative demographics, medical history, associated urinary and sexual dysfunction, and previous treatment, as well as intraoperative time, estimated blood loss (EBL), and surgical techniques. Postoperative outcomes included residual urinary, sexual, and infectious BPR symptoms; wound complications; BPR failure; and death. Wound complications reviewed included hematoma, dehiscence, cellulitis, and surgical site infections. BPR failure was defined as recurrent ABP requiring repeat BPR.
Results:
48 ABP patients underwent BPR between 7/2011 and 12/2018. Mean follow-up was 345.3 (range 0-2173) days. Mean age at presentation was 54.9 (range 27.0-82.1) years. Mean weight and BMI were 294.1 (range 206.0-492.0) lbs and 42.8 (range 28.0-72.1), respectively. Median Charlson Comorbidity Index was 3 (range 0-14). 22.9% (n=11) of the cohort had a urethral stricture history, of which 14.6% (n=7), 6.3% (n=3), 2.1% (n=1) had prior dilation, direct vision internal urethrotomy, and urethroplasty, respectively. 10.4% (n=5) of the cohort had a concurrent urethral stricture at the time of ABP evaluation. None of the penis was visible preoperatively for 52.1% (n=25) of the cohort. 58.3% (n=28) of the cohort had lichen sclerosus (LS) of the urethra or genital skin; 16.7% (n=8) had genital lymphedema. 25% (n=12) of the cohort had prior obesity-related surgery; 2.1% (n=1) had prior BPR. 89.6% (n=43), 60.4% (n=29), and 62.5% (n=30) of the cohort reported urinary dysfunction, sexual dysfunction, and skin or urinary infection reasons for pursuing BPR, respectively. Mean BPR surgical time was 181.4 (range 41-364) min; mean EBL was 84.3 (range 10-700) ml. BPR included escutcheonectomy, penile skin graft, and penile scar release with z-plasty in 52.1% (n=25), 60.4% (n=29), and 10.4% (n=5) of the cohort, respectively. Escutcheonectomy mean area was 229.6 (range 37.5-462.5) cm2 and mean weight was 713.6 (range 82.5-3600) g; mean skin graft area was 167.2 (range 20-900) cm2. 8.3% (n=4) patients had a concurrent urethral procedure at the time of BPR. Postoperatively, 16.7% (n=8), 0% (n=0), and 10.4% (n=5) of the cohort reported residual urinary dysfunction, sexual dysfunction, and skin or urinary infection symptoms, respectively. Clavien grade I-II complications occurred in 18.8% (n=9), whereas Clavien grade III-V complications occurred in 12.5% (n=1 operative hematoma, n=4 BPR failures requiring reoperation, n=1 death within 30 postoperative days) of the cohort. Mean time to repeat BPR was 334.8 (range 152-529) days.
Conclusions:
BPR results in significant improvement in urinary dysfunction, sexual dysfunction, and skin and urinary infection symptoms, with a low risk of buried penis recurrence. Most complications are minor and rarely require operative intervention.


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