Technique of Scrotal Repositioning to Correct Penile Concealment
Gregory C. McMahon, DO1, Sravan Panuganti, DO1, Zarine Balsara, MD PhD2, Gregory Dean, MD FAAP FACS2.
1Rowan University SOM/Jefferson Health/Our Lady of Lourdes, Stratford, NJ, USA, 2Urology For Children / St Christopher's Hospital for Children, Voorhees, NJ, USA.
BACKGROUND: We describe a technique to correct penoscrotal webbing associated with penile concealment. Division of midline scrotal fat permits posterior scrotal repositioning and effectively eliminates the penoscrotal web without dividing it. The distal foreskin unfurls providing ventral skin coverage. Retention of a generous mucosal collar eliminates the inclusion of a reconfigured phimotic band. This technique achieves dorsal/ ventral length symmetry and increase overall penile length. METHODS: Our technique employs a circumferential sub-coronal incision with a longitudinal ventral incision extending to the penoscrotal junction without dividing scrotal skin. This T-type incision, allows degloving of the penile skin as a single sheet from the dorsal surface of the phallus. With the ventral surface of the phallus and the intact scrotal margin exposed, the scrotum is retracted toward the anus and the deep scrotal midline fat brought into the incision and divided. Following division of this fat, space is created to mobilize and reposition the scrotum posteriorly. The natural penoscrotal junction is repositioned rather than divided. The penoscrotal junction is repositioned with 4-0 PDS to a point 4.5 cm from the distal glans ventrally. The penopubic junction is also affixed at a point 4.5 cm proximal to the distal glans yielding a symmetric phallus. The increased shaft length is resurfaced using penile skin, which would have otherwise been discarded using alternative techniques. The presence of a generous mucosal collar eliminates inclusion of the phimotic ring which would otherwise cause narrowing. RESULTS: We have performed this approach in 216 patients with excellent results. Pre-operative dorsal/ventral shaft length asymmetry is effectively corrected by this technique. This approach yields a natural penoscrotal junction, enhanced penile length and does not increase ventral closure tension. CONCLUSIONS: Our approach for correcting penile concealment relies on posterior scrotal repositioning to eliminate penoscrotal webbing. It results in dorsal/ventral penile shaft skin symmetry, a normal penopubic junction and enhanced penile length. This technique is easily performed and should be considered when performing circumcision in the face of penile concealment.
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