Technical nuances for concealed penis repair
Mark R. Zaontz, MD, Christopher J. Long, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: Circumcision is a common procedure but the healing process and the cosmetic outcome can be negatively impacted if congenital anatomic anomalies are present. Penile concealment results from poor skin fixation on the penile shaft or skin deficiency, and can range across a broad spectrum of severity. Penoscrotal webbing, if not identified and corrected at the time of circumcision, can result in a shortened, curved penis with a poor cosmetic outcome. While several techniques exist to repair these anomalies, no gold standard approach is currently in place. We present a video of our techniques for concealed penis and penoscrotal webbing.
Methods: We included all patients undergoing repair during a period from 2015-2022. Paraphimotic band technique is described, utilizing dorsal and ventral midline incisions to align the penile skin and to remove penoscrotal webbing and to correct any skin discrepancy. After degloving, anchoring sutures at the 12, 5, and 7 o’ clock positions correct the concealment and fix the penoscrotal junction in place. Complex scrotoplasty is performed if insufficient ventral shaft skin is present for the paraphimotic band approach alone. This technique differs in that an inverted Y incision is performed on the ventral aspect of the penile shaft, allowing for skin mobilization and subsequent approximation to correct the dorsal-ventral shaft skin discrepancy.
Results: A total of 488 patients met inclusion criteria. 438 underwent the paraphimotic band technique while 50 also required a complex scrotoplasty repair. Median age at surgery was 9 months (range 5 months - 15. Years). Mean follow up was 6 weeks. No surgical complications were noted.
Conclusions: Our technique for concealed penis with or without scrotoplasty is reproducible and has a low complication rate. The paraphimotic band approach obviated the need for complex scrotoplasty in the majority of our patients. When required, the inverted Y scrotoplasty corrects severe penoscrotal webbing.
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