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26.10.2017 | Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors) | Ausgabe 4/2017

Current Sexual Health Reports 4/2017

Surgical Management of the Concealed Penis in Adults

Zeitschrift:
Current Sexual Health Reports > Ausgabe 4/2017
Autoren:
Matthew R. Danzig, Lisa M. Parrillo, Ty T. Higuchi
Wichtige Hinweise
This article is part of the Topical Collection on Male and Female Surgical Interventions

Abstract

Purpose of Review

The concealed penis in adults is a relatively rare indication for surgical treatment; however, it represents a complex disease spectrum requiring thoughtful, systematic management. Here, we review the fundamental principles underlying a successful repair and highlight recent surgical techniques and pathways.

Recent Findings

In evaluated patients with adult concealed penis, clinicians should be aware of the association of this condition with urethral stricture, carcinoma of the penis, and angiosarcoma in the setting of lymphedema. It may not be possible to complete this evaluation prior to operative exploration, although adjunctive studies such as MRI can be helpful. In addition, surgical reconstruction may involve urologist and plastic surgeons. All successful repairs involve the key steps of excising scar tissue and abnormal skin, freeing abnormal attachments, reducing suprapubic adiposity if indicated, dividing the suspensory ligament if additional release is needed, tacking superficial and deep tissues together to maintain sharp penopubic and penoscrotal angles, and achieving adequate skin coverage with local tissue if possible and skin grafting if necessary. Adjunctive measures such as fibrin glue and wound VAC application can improve the success of skin grafts. Patients can experience significant benefit in many domains following repair including hygiene, sexual function, and well-being.

Summary

Surgical treatment of the adult concealed penis can be highly challenging and complex. However, excellent outcomes can be obtained through a careful and thorough workup, the use of a systematic surgical approach with respect for regional anatomy and careful attention to key principles, and multi-disciplinary collaboration.

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Literatur
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