V1-12: Surgical Management of Adult Acquired Buried Penis (AABP)
Adult acquired buried penis as a result of obesity is a morbid condition. Affected patients have poor sexual function, urinary dribbling, mood disturbance, and poor quality of life (QoL). Weight loss is ineffective due to chronic skin changes and suprapubic fat pad (termed the escutcheon) lymphedema. Previous efforts have described limited repairs including isolated resection of the escutcheon which unfortunately often leads to reburying. We present a surgical repair including escutcheonectomy, scrotoplasty, and penile degloving with split-thickness skin graft (STSG) to provide definitive repair and halt the progression of the disease process.
A retrospective chart review was conducted of patients managed surgically for adult acquired buried penis in 2015-2016. Twelve patients were identified that underwent escutcheonectomy, scrotoplasty, penile degloving and STSG repair. All patients had morbid obesity as a sole etiology or significant contributing factor. Outcomes evaluated were surgical complications, reburying of the penis, graft take rate, and urinary symptoms.
Twelve patients underwent repair of adult acquired buried penis. All patients had good cosmetic results and durable unburying at intermediate term follow-up. Mean patient body mass index (BMI) was 45.4 ± 3.7. Fifty percent of the patients in the series were diabetics and 50% had hypertension and hyperlipidemia (Table 1). Mean operative time, length of stay (LOS), and estimated blood loss (EBL) were 312 ± 59 min, 5.3 ± 1.1 days, and 304 ± 133 cc respectively. STSG take rate was 80-100% (mean 92%) (Table 2).
Adult acquired buried penis is a challenging condition to treat. Limited surgical repairs can lead to reburying of the penis, need for further procedures, and the progression of urethral disease with voiding dysfunction. Escutcheonectomy, scrotoplasty, and STSG has encouraging intermediate term outcomes with durable unburying of the penis and good STSG take rates. Further follow-up in larger series is needed but results are thus far encouraging.