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No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis

International Journal of Impotence Research (2024)Cite this article

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Abstract

Adult Acquired Buried Penis (AABP) is a pathological condition necessitating surgical correction, ranging from simple to complex procedures involving the utilization of full-thickness (FTSG) or split-thickness (STSG) skin grafts especially in cases of substantial viable penile skin loss. In this retrospective study, we aimed to compare the surgical, functional, and patient-reported outcomes (PROs) of graft types that were utilized to treat AABP among 39 patients at a single center between November 2017 and May 2023. Among these patients, 22 needed skin grafts, with 9 undergoing FTSG and the remainder receiving STSG. Lichen Sclerosus (LS) was the primary cause (54.6%) of AABP requiring skin grafts. Patients primarily presented with voiding (63.6%) and sexual (27.3%) dysfunction. The STSG group had a lower mean age (64.7 ± 11.6) than the FTSG group (66.7 ± 11.6; P = 0.015), with no significant differences in BMI (p = 0.643). Complex repairs (Santucci grade ≥3) were performed in 81.0% of cases, with 88.9% in the FTSG group and 75.0% in the STSG group. Operative times were similar (160.2 ± 31.7 vs 161.5 ± 50.3, p = 0.945). No significant differences in preoperative penis length were found between the FTSG and STSG groups (P = 0.918). Postoperative complications occurred in 36.4% of patients, with severe complications (Clavien grade ≥3) in 9.1%. General postoperative complications and recurrence rates did not significantly differ between groups (P = 0.397 and 0.375; respectively). Functional outcomes, evaluated using the International Index of Erectile Function and the International Prostate Symptom Score, improved significantly in both groups after surgical procedures (P < 0.001 for all). Patient-reported satisfaction for the operation was 81.3% calculated by ad-hoc questionnaire. In conclusion, no discernible differences in outcomes were observed between STSG and FTSG. Larger comparative studies with extended follow-up periods and validated questionnaires are warranted for confirmation. Physicians should consider specialized centers for AABP surgical repair due to its intricacies.

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Fig. 1: Step-by-step surgical approach employed in this study.
Fig. 2: Harvesting the skin graft or using local flaps.
Fig. 3: The complexity of surgery procedures according to Santucci classification [17].
Fig. 4: Post-surgical complications according to the type of skin graft used.

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Data availability

The data that support the findings of this study are available from the corresponding author (SW) upon reasonable request.

References

  1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

  2. Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep. 2018;20:12.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Staniorski CJ, Myrga JM, Vasan RV, Klein RD, Rusilko PJ. Surgical Outcomes and Prediction of Complications Following High-complexity Buried Penis Reconstruction. J Urol. 2023;210:782–90.

  4. Cohen PR. Adult Acquired Buried Penis: A Hidden Problem in Obese Men. Cureus. 2021;13:e13067.

    PubMed  PubMed Central  Google Scholar 

  5. Hamaguchi R, Francis AM, Kramer KM, Lian CG, O’Leary MP, Orgill DP. Multimodal Surgical Management of Severe Scrotal Lymphedema and Buried Penis. Urology. 2020;144:e19–e23.

    Article  PubMed  Google Scholar 

  6. Kara Ö, Teke K, Çiftçi S, Üstüner M, Uslubaş AK, Bosnalı E, et al. Buried penis in adults as a complication of circumcision: Surgical management and long-term outcomes. Andrologia. 2021;53:e13921.

    Article  PubMed  Google Scholar 

  7. Monn MF, Chua M, Aubé M, DeLong JM, McCammon KA, Gilbert D, et al. Surgical management and outcomes of adult acquired buried penis with and without lichen sclerosus: a comparative analysis. Int Urol Nephrol. 2020;52:1893–8.

    Article  PubMed  Google Scholar 

  8. Pekala KR, Pelzman D, Theisen KM, Rogers D, Maganty A, Fuller TW, et al. The Prevalence of Penile Cancer in Patients With Adult Acquired Buried Penis. Urology. 2019;133:229–33.

    Article  PubMed  Google Scholar 

  9. Amend GM, Holler JT, Sadighian MJ, Rios N, Hakam N, Nabavizadeh B, et al. The Lived Experience of Patients with Adult Acquired Buried Penis. J Urol. 2022;208:396–405.

    Article  PubMed  Google Scholar 

  10. Rybak J, Larsen S, Yu M, Levine LA. Single center outcomes after reconstructive surgical correction of adult acquired buried penis: measurements of erectile function, depression, and quality of life. J Sex Med. 2014;11:1086–91.

    Article  PubMed  Google Scholar 

  11. Theisen KM, Fuller TW, Rusilko P. Surgical Management of Adult-acquired Buried Penis: Impact on Urinary and Sexual Quality of Life Outcomes. Urology. 2018;116:180–4.

    Article  PubMed  Google Scholar 

  12. Voznesensky MA, Lawrence WT, Keith JN, Erickson BA. Patient-Reported Social, Psychological, and Urologic Outcomes After Adult Buried Penis Repair. Urology. 2017;103:240–4.

    Article  PubMed  Google Scholar 

  13. Tausch TJ, Peterson AC. Early aggressive treatment of lichen sclerosus may prevent disease progression. J Urol. 2012;187:2101–5.

    Article  PubMed  Google Scholar 

  14. Fuller TW, Theisen K, Rusilko P. Surgical Management of Adult Acquired Buried Penis: Escutcheonectomy, Scrotectomy, and Penile Split-thickness Skin Graft. Urology. 2017;108:237–8.

    Article  PubMed  Google Scholar 

  15. Hesse MA, Israel JS, Shulzhenko NO, Sanchez RJ, Garland CB, Siebert JW, et al. The Surgical Treatment of Adult Acquired Buried Penis Syndrome: A New Classification System. Aesthet Surg J. 2019;39:979–88.

    Article  PubMed  Google Scholar 

  16. Mirastschijski U. Classification and Treatment of the Adult Buried Penis. Ann Plast Surg. 2018;80:653–9.

    Article  CAS  PubMed  Google Scholar 

  17. Pariser JJ, Soto-Aviles OE, Miller B, Husainat M, Santucci RA. A Simplified Adult Acquired Buried Penis Repair Classification System With an Analysis of Perioperative Complications and Urethral Stricture Disease. Urology. 2018;120:248–52.

    Article  PubMed  Google Scholar 

  18. Tausch TJ, Tachibana I, Siegel JA, Hoxworth R, Scott JM, Morey AF. Classification System for Individualized Treatment of Adult Buried Penis Syndrome. Plast Reconstr Surg. 2016;138:703–11.

    Article  CAS  PubMed  Google Scholar 

  19. Monn MF, Socas J, Mellon MJ. The Use of Full Thickness Skin Graft Phalloplasty During Adult Acquired Buried Penis Repair. Urology. 2019;129:223–7.

    Article  PubMed  Google Scholar 

  20. Boonjindasup A, Pinsky M, Stewart C, Trost L, Chaffin A, Jansen D, et al. Management of adult concealed penis using a meshed, split-thickness skin graft. Can Urol Assoc J. 2016;10:E407–e411.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gillett MD, Rathbun SR, Husmann DA, Clay RP, Kramer SA. Split-thickness skin graft for the management of concealed penis. J Urol. 2005;173:579–82.

    Article  PubMed  Google Scholar 

  22. Cocci A, Cito G, Falcone M, Capece M, Di Maida F, Morelli G, et al. Subjective and objective results in surgical correction of adult acquired buried penis: A single-centre observational study. Arch Ital Urol Androl. 2019;91:25–29.

    Article  PubMed  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  24. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  CAS  PubMed  Google Scholar 

  25. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–57.

    Article  CAS  PubMed  Google Scholar 

  26. Badía X, García-Losa M, Dal-Ré R. Ten-language translation and harmonization of the International Prostate Symptom Score: developing a methodology for multinational clinical trials. Eur Urol. 1997;31:129–40.

    Article  PubMed  Google Scholar 

  27. Strother MC, Skokan AJ, Sterling ME, Butler PD, Kovell RC. Adult Buried Penis Repair with Escutcheonectomy and Split-Thickness Skin Grafting. J Sex Med. 2018;15:1198–204.

    Article  PubMed  Google Scholar 

  28. Garaffa G, Shabbir M, Christopher N, Minhas S, Ralph DJ. The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature. J Sex Med. 2011;8:1246–53.

    Article  PubMed  Google Scholar 

  29. Falcone M, Preto M, Timpano M, Oderda M, Plamadeala N, Cirigliano L, et al. The outcomes of surgical management options for adult acquired buried penis. Int J Impot Res. 2023;35:712–19.

    Article  PubMed  Google Scholar 

  30. Fam MM, Hanna MK. Resurfacing the Penis of Complex Hypospadias Repair (“Hypospadias Cripples”). J Urol. 2017;1972:859–64.

    Article  Google Scholar 

  31. Lei J, Luo C, Wang X, Su X. A novel “six stitches” procedures for pediatric and adult buried penis. Int Braz J Urol. 2019;45:190–1.

    Article  PubMed  PubMed Central  Google Scholar 

  32. He H, Li Q, Xu T, Zhang X. Treatment of adult-acquired buried penis with suprapubic liposuction combined with modified Devine operation. Beijing Da Xue Xue Bao Yi Xue Ban. 2022;54:741–5.

    CAS  PubMed  Google Scholar 

  33. Wahyudi I, Hadiansyah H, Situmorang GR, Rodjani A. Risk factors for surgical complications and short-term outcomes evaluation after novel method of buried penis correction: A single-center experience. J Pediatr Urol. 2022;18:677.e671–677.e611.

    Article  Google Scholar 

  34. Hampson LA, Muncey W, Chung PH, Ma CC, Friedrich J, Wessells H, et al. Surgical and Functional Outcomes Following Buried Penis Repair With Limited Panniculectomy and Split-thickness Skin Graft. Urology. 2017;110:234–8.

    Article  PubMed  Google Scholar 

  35. Aubé M, Chua M, DeLong J, McCammon K, Tonkin J, Gilbert D, et al. Predictors of surgical complications and evaluation of outcomes after surgical correction of adult-acquired buried penis. Int Urol Nephrol. 2020;52:687–92.

    Article  PubMed  Google Scholar 

  36. Salako AA, Olabanji JK, Oladele AO, Alabi GH, Adejare IE, David RA. Surgical Reconstruction of Giant Penoscrotal Lymphedema in Sub-Saharan Africa. Urology. 2018;112:181–5.

    Article  PubMed  Google Scholar 

  37. Frenkl TL, Agarwal S, Caldamone AA. Results of a simplified technique for buried penis repair. J Urol. 2004;171:826–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Selcuk University School of Medicine, Konya, Turkey

    Murat Gül

  2. Urology Clinic - A.O.U. “Città della Salute e della Scienza” – Molinette Hospital, University of Turin, Turin, Italy

    Natalia Plamadeala, Marco Falcone, Mirko Preto, Lorenzo Cirigliano, Federica Peretti, Ilaria Ferro, Martina Scavone & Paolo Gontero

  3. Neurourology Clinic - A.O.U. “Città della Salute e della Scienza” - Unità Spinale Unipolare, Turin, Italy

    Marco Falcone

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Correspondence to Marco Falcone.

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Gül, M., Plamadeala, N., Falcone, M. et al. No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00832-7

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