V1-09: Repair of Adult Buried Penis with Removal of Suprapubic Fat Pad and Split Thickness Skin Graft: Emphasis on Patient Body Habitus
Repair of adult acquired buried penis is a challenging surgical problem with potential for substantial morbidity when complications occur. Just a few of the post-operative problems can include: recurrence of buried penis, damage to genitourinary structures, wound breakdown / infection, and loss of split thickness skin graft. We present a technique for buried penis repair with removal of suprapubic fat pad, penile split thickness skin graft, emphasizing the importance of patient body habitus._x000D_
We reviewed records of patients undergoing a consistent technique for adult buried penis repair from 2014-2016. Information was gathered on patient demographics, past medical history, concomitant problems (such as urethral stricture, and lymphedema), and outcomes. Important aspects of surgical technique involve complete resection of the suprapubic fat pad, removal of scarred penile skin, reconstruction of the peno-abdominal and peno-scrotal junction, and split thickness skin graft of the penis._x000D_
Seven men were identified. Mean age and BMI were 40 (range 21-65 years) and 48 kg/m2 (range 39-65 kg/m2). Four patients had distal urethral stricture and required 1st stage urethroplasty of the meatus and fossa navicularis. Two patients had concomitant scrotal lymphedema and required scrotectomy with reconstruction with local flaps. Some graft loss occurred in 57%. Graft loss ranged from 20% to 50%. All patients were managed conservatively and no patients required re-grafting or additional peri-operative procedures. No patients had recurrence of buried penis or required further intervention. _x000D_
Anatomic attachment of the abdominal pannus above the supra pubic fat pad is variable among patients and an important pre-operative consideration potentially mitigating the risk of recurrence of buried penis. Wound complications are common, but generally heal with conservative measures.