Bilommi R
Posters-Accepted Abstracts: Med Surg Urol
Introduction: Inconspicuous penis refers to a constellation of conditions that make the penis look diminutive and small. These conditions are poor penile suspension, buried penis, webbed penis, trapped penis, concealed penis, diminutive penis and congenital chordae with and without hypospadias. Proper treatment is dependent on accurately diagnosing which entity is present. Materials & Methods: We reviewed the records of patients treated for inconspicuous penis and severe hypospadias. We categorized the cases as penoscrotal webbing or megaprepuce buried penis (webbed penis), developmental conditions like prepubic adiposity that overhang the penis (buried penis or concealed penis) and iatrogenic causes like trapped penis after adhesions secondary to circumcision (trapped penis), congenital chordae with or without hypospadias and only severe hypospadias with phenoscrotal transpotition. For the inconspicuous penis and the congenital chordae, all patients underwent complete penile degloving, for the trapped penis the cicatricial scar that trapped the penis was excised. Webbed penis was surgically repaired as was the combined buried and webbed penis. Penile skin flaps and Z-plasties were used; scrotal skin flaps were used for reconstruction. In buried and concealed penis patients the penile skin was fixed with sutures to maintain penile length. For the severe hypospadias we performed scardino ehrlich scroplasty, chordectomy and urethroplasty (ducket, lateral based flap, konayagi). Results: Surgical results were uniformly good for the inconspicuous penis and the congenital chordate. The repairs were all successful and had no complications. For the severe hypospadias, 30% had uretrocutaneous fistula. Conclusions: Inconspicuous penis and severe hypospadias is a very serious condition and need surgical correction. Reconstruction is warranted in appropriate cases to avoid future psychosexual issues and provide the child with normal functional anatomy.
