Introduction: Adult acquired buried penis is a clinical phenotype with several potential etiologies, and the mainstay of current management is surgical repair. While there is a high incidence of postoperative complications, current literature reflects high patient satisfaction with buried penis repair. To date, little is known about the need for surgical revision or risk factors for recurrence of the buried penis phenotype.
Methods: A retrospective review was conducted of all patients evaluated for adult acquired buried penis at a single high-volume academic referral center. All patients who underwent a surgical intervention from August 2013 – August 2019 with documented follow-up of at least 60 days were included. Patient demographics, perioperative course, and complications were reviewed.
Results: There were 55 patients who underwent primary surgical repair during the study period. Baseline patient demographics and operative details are summarized in Table 1. Median duration of follow-up was 1.1 years, and 27.2% of patients (15/55) were identified to have bothersome recurrent or persistent penile concealment. Recurrences were attributed to lymphedema (46.7%, 7/15), residual redundant soft tissue (20%, 3/15), genital skin tethering/scarring (20%, 3/15), or pannus recurrence/enlargement (13.3%, 2/15). Most patients (73.3%, 11/15) underwent a revision surgery with good subsequent results. This included revision scrotoplasty/scrotectomy in 6 patients, skin grafting of the penis in 3, and revision panniculectomy in 2. Among candidate variables, only baseline body mass index (BMI) demonstrated a significant correlation with recurrent/persistent penile concealment (p=0.031).
Conclusions: Patients with acquired adult buried penis may require more than one surgery to achieve a functionally satisfactory outcome. Given the prevalence of comorbid conditions and the known high incidence of early complications, efforts to diminish the likelihood of revision surgery stand to benefit this cohort. While BMI was identified as a candidate risk factor, the impact of preoperative weight loss on the need for revision surgery remains unclear. Exploration of innovations in surgical technique is also needed to limit the risk of phenotypic recurrence. Source of