External phallopexy: A revisited technique and algorithm for simple management of buried penis

• Published in: Journal of pediatric surgery Vol. 58; no. 3; pp. 580 - 586
• Main Authors: Radwan, Ahmed Bassiouny, GadAllah, Mohammed AbdelSattar, Soliman, Mohammed Hesham, AbouZeid, Amr Abdelhamid
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2023
• Subjects: Buried penis; Child; Child, Preschool; Epispadias - surgery; Humans; Hypospadias - surgery; Male; Penis - surgery; Phallopexy; Phalloplasty; Prospective Studies; Short penis; Urethra; Urologic Surgical Procedures, Male - methods; Phalloplasty; Short penis; Phallopexy; Buried penis
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.07.028

•Many classification systems present.•Variable correction techniques.•What new information is contained in this article?•Definition of BP in children.•Algorithm, simple technique of correction used prospectively.•Penopubic angle as crossroad of technique selection.
Buried penis (BP) is a distressing condition for both the child and his caregivers. A lot of techniques are available for the management of such condition. External phallopexy represents a simple technique designed for selected cases. This study aimed at reexploring the technique of “3 stitches phallopexy” in the context of correction of selected cases with BP, validating a prospectively designed algorithm for BP management, and detecting the parental satisfaction and possible complications of this technique.
This was a prospective study performed over a 2 years’ period on cases diagnosed with BP. Patients were excluded if they have previous urethral repair e.g., hypospadias or epispadias, BP with normal penopubic angle, micropenis, and insufficient skin coverage after phallopexy simulation test. A questionnaire with 0–12 points score was used for assessment of satisfaction by caregivers.
28 cases were included, with a mean age at the procedure of 5.03±2.6 years. The mean BMI was 15.25±1.1. The intraoperative flaccid penile length measurement was 4.74±1.62 cm, and the mean gained extra-length with phallopexy simulation test was 1.8±0.63 cm. The mean operative time was 20±7 minutes. No wound infection was noted. 2 cases were concerned about the stitch marks at the penopubic junction skin. No recurrence of symptoms was reported after at least 6 months (mean11±4 months) follow up. The mean preoperative satisfaction score was 4.7±1.2, while at the 6 months follow up visit it rose to 10.8±0.67.
External phallopexy represents a simple technique for managing buried penis, with minimal complications during follow up period and satisfactory cosmetic outcome.