title: Single center outcomes after reconstructive surgical correction of adult acquired buried penis: measurements of erectile function, depression, and quality of life.
abstract: BACKGROUND
  Management of adult acquired buried penis is a troublesome situation for both patient and surgeon. The buried penis has been associated with significant erectile and voiding dysfunction, depression, and overall poor quality of life (QOL).
  
  
  OBJECTIVE
  To identify outcomes following reconstructive surgery with release of buried penis, escutcheonectomy, and circumcision with or without skin grafting.
  
  
  METHODS
  We retrospectively identified 11 patients treated by a single surgeon between 2007 and 2011, patient ages were 44-69; complete data review was available on all 11.
  
  
  METHODS
  Validated European Organisation for Research and Treatment of Cancer 15 QOL, Center for Epidemiologic Studies Depression Scale (CES-D), and International Index of Erectile Function (IIEF) surveys assessed patient QOL, depression, and erectile function pre- and postoperatively.
  
  
  RESULTS
  Mean body mass index (BMI) was 48.8 (42.4-64.6). Mean operative time was 191 minutes (139-272). Mean length of stay was 2.1 days. Ten of 11 patients required phallic skin grafting. There was one perioperative complication resulting in respiratory failure and overnight stay in the intensive care unit. Wound complications were seen in 2/11 patients, and 1 needed surgical debridement for superficial wound infection. Skin graft take was seen in 100% of the patients. Ninety-one percent of patients noted significant improvement in voiding postoperatively. Ninety-one percent of patients reported significant erectile dysfunction preoperatively. Subsequently, IIEF scores improved post surgery by an average of 7.7 points. Clinical depression was noted to be present in 7/11 patients preoperatively and 2/11 postoperatively based on CES-D surveys. QOL improved significantly in 10/11 compared with preoperative baseline; however, many patients noted significant difficulties based on their weight and other comorbidities.
  
  
  CONCLUSIONS
  Management of adult acquired buried penis is a challenging, yet correctable problem. In our series it appears that by using established surgical techniques we were able to achieve significant improvements in erectile function, QOL, and measures of depression.
authors.affiliation: Department of UrologyRush University Medical CenterChicagoILUSA.
authors.forename: James
authors.initials: J
authors.lastname: Rybak
authors.affiliation: Department of UrologyRush University Medical CenterChicagoILUSA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Larsen
authors.affiliation: Department of UrologyRush University Medical CenterChicagoILUSA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of UrologyRush University Medical CenterChicagoILUSA. Electronic address: drlevine@hotmail.com.
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D002944:Circumcision, Male / Q000379:methods; D003866:Depressive Disorder / Q000209:etiology; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000523:psychology / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods
keywords: Buried Penis; Erectile Dysfunction