A Validation Study of a Simplified Acquired Buried Penis Repair Classification System: Perioperative Complications and Outcomes
Alexander Rozanski, MD, Lawrence Zhang, BA, Jaime Cavallo, MD, Alex Vanni, MD.
Lahey Hospital and Medical Center, Burlington, MA.
Background: A recently published buried penis repair classification system has been proposed to better predict perioperative complications and outcomes (Pariser et al, 2018). Our objective was to validate this classification system at our reconstructive center and assess its utility in predicting patient outcomes.
Methods: Patients who underwent buried penis repair by a single surgeon between January 2012-December 2018 were included. The proposed classification system is as follows: Category I - penile unburying with local skin flap; II - skin graft; III - scrotal surgery; IV - escutcheonectomy; V - abdominal panniculectomy. High complexity was defined as category III or higher. Perioperative 90-day Clavien-Dindo complications were assessed. Failure was defined as the need for additional unburying surgery.
Results: Fifty patients underwent repair with 88% considered highly complex. Median body mass index (BMI) was significantly higher in the high complexity group (41 vs. 33 kg/m2, p = 0.004). Thirteen (26%) patients had urethral strictures with no association to surgical complexity (p = 0.17). In the high complexity group, 3 (7%) patients had high grade complications (Clavien ≥ 3). There were zero complications, low or high grade, in the low complexity group. At a median follow-up of 10.4 months, successful repair was achieved in 90%. All failures occurred in the high complexity group.
Conclusions: Utilizing this classification system as a predictor of perioperative outcomes, our study validates the pilot study findings. Patients requiring high complexity repairs have a higher BMI. High grade complications and failures only occurred in the high complexity group. Further multi-institutional studies should be pursued to assess this classification system and to refine important clinical variables and operative techniques to maximize patient goals and predict patient outcomes. 
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