Benign penile skin anomalies in children:a primer for pediatricians

Background:Abnormalities involving the skin coverage of the penis are diffi cult to defi ne,but they can significantly alter penile appearance,and be a cause of parental concern.Data sources:The present review was based on a non-systematic search of the English language medical literature using a combination of key words including"penile skin anomalies"and the specific names of the different conditions.Results:Conditions were addressed in the following order,those mainly affecting the prepuce(phimosis,balanitis xerotica obliterans,balanitis,paraphimosis),those which alter penile configuration(inconspicuous penis and penile torsion),and lastly focal lesions(cysts,nevi and vascular lesions).Most of these anomalies are congenital,have no or minimal influence on urinary function,and can be detected on clinical examination.Spontaneous improvement is possible.In the majority of cases undergoing surgery,the potential psychological implications of genital malformation on patient development are the main reason for treatment,and the age generally recommended for surgery is after 12 months of age.Conclusion:This review provides the pediatrician with a handy tool to identify the most common penile skin anomalies,counsel parents adequately,make sensible and evidence based choices for management,and recognize complications or untoward outcomes in patients undergoing surgery.

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.