Concealed penis in pediatric age group: a comparison between three surgical techniques.

BACKGROUND: Comparison between three different surgical techniques in the management of concealed penis. METHODS: This prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out. RESULTS: Penile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B. CONCLUSIONS: Phallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis. CLINICAL TRIAL REGISTRATION: The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System. CLINICALTRIALS: gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022.

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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: External phallopexy represents a simple technique for managing buried penis, with minimal complications during follow up period and satisfactory cosmetic outcome.

Two levels vs. one level of phallopexy in the treatment of concealed penis in patients in pediatric age group.

Introduction: Concealed penis, which is the congenital type of buried penis, is a condition in which a normal-sized penis is totally or partially hidden by pubic, scrotal, or thigh skin. Several procedures had been described for its correction including phallopexy, that is, fixation of penile Buck's fascia to the sub-dermis. Aim of the work: Our work aims to study the difference in outcome between performing phallopexy at one level and at two levels. Material and methods: Our study included 180 uncircumcised patients who had a concealed penis while having an average length of an outstretched penis. These patients were divided into two groups: the first one was treated with one level of phallopexy at the 3 and 9 o'clock points, while the second group was treated with the same procedure in addition to another level of stitches at the mid-penile level. The follow-up was carried out for one post-operative year regarding penile skin edema, infection, congestion, necrosis, and/or re-retraction. Results: The overall success rate was 96.1% for a normally-looking penis without post-operative re-retraction. Re-retraction developed in two patients (2.2%) of those who had one-level phallopexy and in five patients (5.6%) of those who had two-level phallopexy without statistical significance (FE p = .444). Penile skin edema developed in 76 patients (42.2%) being significantly lower in patients with lower body weight (p = .030*). Conclusion: Phallopexy could be performed safely in the case of the concealed penis with satisfactory results. Two levels of phallopexy did not add any advantage to the post-operative results besides the fact that this may be demanding, time-consuming, and may require higher resources, so we recommend the easier one-level phallopexy in the treatment of such conditions with satisfactory results.

Combined preputial advancement and phallopexy as a revision technique for treating paraphimosis in a dog.

A 7-year-old neutered male Jack Russell terrier-cross was presented for signs of recurrent paraphimosis, despite previous surgical enlargement of the preputial ostium. Revision surgery was performed using a combination of preputial advancement and phallopexy, which resulted in complete and permanent coverage of the glans penis by the prepuce, and at 1 year postoperatively, no recurrence of paraphimosis had been observed. The combined techniques allow preservation of the normal penile anatomy, are relatively simple to perform and provide a cosmetic result. We recommend this combination for the treatment of paraphimosis in the dog, particularly when other techniques have failed.