A modified fixation technique for the treatment of buried penis in children

For many years,surgical treatment of buried penis in children has been researched by several scholars,and numerous methods exist.This study aimed to explore the clinical effect of a modified fixation technique in treating buried penis in children.Clinical data of 94 patients with buried penis who were treated using the modified penile fixation technique from March 2017 to February 2019 in Fujian Maternity and Child Health Hospital(Fuzhou,China)were retrospectively collected,compared,and analyzed.Clinical data of 107 patients with buried penis who were treated using traditional penile fixation technique from February 2014 to February 2017 were chosen for comparison.The results showed that at 6 months and 12 months after surgery,the penile lengths in the modified penile fixation group were longer than those in the traditional penile fixation group(both P<0.05).The incidence of postoperative skin contracture and penile retraction in the modified penile fixation group was less than that in the traditional penile fixation group(P=0.034 and P=0.012,respectively).When the two groups were compared in terms of parents'satisfaction scores,the scores for penile size,penile morphology,and voiding status in the modified penile fixation group were higher than those in the traditional penile fixation group at 2-week,6-month,and 12-month follow-ups after surgery(all P<0.05).We concluded that the modified penile fixation technique could effectively reduce the incidence of skin contracture and penile retraction and improve the penile length and satisfaction of patients'parents.

Buried penis:a histological and histochemical study of dartos fascia

This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis.Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of dartos fascia under a microscope.Penile length was measured before and after completely resecting the deep layer to investigate the role of this layer in penile retraction.The superficial and deep layers of dartos fascia were collected from 49 patients with buried penis,the normal superficial layers were collected from 25 children/adults who underwent circumcision for nonmedical reasons,and the normal deep layers were collected from 20 adult cadavers.The penile fascia samples were stained with hematoxylin-eosin,Masson’s trichrome,Sirius red,and Verhoeff’s Van Gieson,and subjected to immunohistochemical examination and scanning electron microscopy.The penile shaft(mean±standard deviation)was found to be significantly elongated after resecting the deep layer compared with that before resection(6.8±1.9 cm vs 6.0±1.6 cm,P<0.001).An abnormal deep layer of dartos fascia characterized by disordered and fragmented elastic fibers was observed in 87.8%(43/49)of buried penis samples,whereas no abnormal deep layer was observed in normal penises from cadavers(0/20,P<0.001).Thus,the abnormal deep layer of dartos fascia plays an important role in the buried penis.Its resection is helpful for avoiding recurrence.

Effects of buried penis on the structure and function of corpus cavernosum in a rat model

Background While the abnormal appearance of the concealed penis has been well recognized, the effect of buried penis on the structure and function of corpus cavernosum has not been well studied. To explore this issue, we established a rat model and evaluated the effect of buried penis on cavernosum weight, contents and ultrastructure of tissue, and nitric oxide synthase （NOS） activity. Methods Two hundred and ten rats were randomly divided into 3 equal cohorts for 2, 4 and 6 months study （groups A, B and C）. Each group was randomly divided into buried group （n=40）, control group （n=15）, and normal group （n=15）, respectively. Intra-purse-string suture of the root of the penis was used to establish the model. Macroscopic development was judged by measuring the weight of the corpus cavernosum. Masson＇s trichrome staining was performed for observing microstructure while a transmission electron microscope was used for observing ultrastructure. The NOS activity was detected by a NOS activity assay kit. Results Buried penis had no significant influence on the appearance and weight of the corpus cavernosum. Buried penis resulted in decreased smooth muscle content （P 〉0.05 in group A, and P 〈0.05 in groups B and C） and increased fibrous connective tissue content （P 〉0.05 in groups A and B, and P 〈0.05 in group C） compared with the normal and control groups. Ultrastructural abnormalities of corpus cavernosum were observed in the 6-month buried group. Moreover, there was decrease of NOS activity in groups B and C （P 〈0.05 in group B and P 〈0.01 in group C） when compared with the normal and control groups. Conclusion Buried penis affects the structure and function of corpus cavernosum in rats and the effect is positively correlated with the buried time, but there is no significant effect on the macroscopic development.

Reconstruction of the male external genitalia in diverse disease processes:Our reconstructive algorithm,techniques,and experience

Background:Male genital form and function may be rendered abnormal by a number of disease processes,with profound associated psychological and functional consequences.The aim of the study is to review our reconstructive experience with cases of genital loss or distortion due to nonmalignant diseases processes and atypical neoplasia.Materials and methods:A retrospective review of a prospectively maintained database was performed to identify reconstructive cases performed from 2018 to 2020 under the care of a single surgeon.Male patients 18 years or older with a disease diagnosis other than squamous cell carcinoma affecting genital form were included.Disease processes,patient factors,surgical techniques,and both functional and cosmetic outcomes were reviewed.Results:Fourteen cases were identified.The patients had a mean age of 52.2 years(range,21-72 years).Acquired buried penis was present in 8 patients.Etiology of genital abnormality included balanitis xerotica obliterans(n=6),excess skin loss at circumcision(n=2),self-injection of petroleum jelly to penile shaft(n=1),Fournier gangrene(n=1),hidradenitis suppurativa(n=1),extramammary Paget disease(n=1),idiopathic lymphoedema(n=1),and penoscrotal webbing(n=1).Reconstructive techniques performed included penile debridement/shaft skin release,scrotectomy,suprapubic apronectomy,and division of penoscrotal webbing,in combination with split-thickness skin grafting where required.A penile implant was inserted in one patient.Reconstructive planning,techniques,and outcomes are described.Conclusions:A variety of reconstructive techniques in andrology can be used to improve the aesthetic and functional outcomes of multiple disease processes affecting the male external genitalia.