title: Correction of concealed penis with preservation of the prepuce.
abstract: BACKGROUND
  By definition, congenital concealed penis presents at birth. Children are usually referred to physicians because of parental anxiety caused by their child's penile size.
  
  
  OBJECTIVE
  Several surgical procedures have been described to treat this condition, but its correction is still technically challenging. The present study reports a simple surgical approach, which allows preservation of the prepuce.
  
  
  METHODS
  During the last 6 years, 18 children with concealed penis (according to the classification by Maizels et al.) have been treated in the present department (mean age 4.5 years, range 3-12 years). Patients with other conditions that caused buried penis were excluded from the study. The operation was performed through a longitudinal midline ventral incision, which was extended hemi-circumferentially at the penile base. The dysgenetic dartos was identified and its distal part was resected. Dissection of the corpora cavernosa was carried down to the suspensory ligament, which was sectioned. Buck's fascia was fixed to Scarpa's fascia and shaft skin was approximated in the midline. Penoscrotal angle was fashioned by Z-plasty or V-Y plasty.
  
  
  RESULTS
  The median follow-up was 24 months (range 8-36). The postoperative edema was mild and resolved within a week. All children had good to excellent outcomes. The median pre-operative to postoperative difference in penile length in the flaccid state was 2.6 cm (range 2.0-3.5). No serious complications or recurrent penile retraction were noted.
  
  
  CONCLUSIONS
  Recent literature mostly suggests that concealed penis is due to deficient proximal attachments of dysgenetic dartos. Consequences of this include: difficulties in maintaining proper hygiene, balanitis, voiding difficulties with prepuce ballooning and urine spraying, and embarrassment among peers. Surgical treatment for congenital concealed penis is warranted in children aged 3 years or older. The basis of the technique is the perception that in boys with congenital concealed penis, the penile integuments are normal but they have abnormal attachments, and that incision of the skin and dartos will allow the shaft to extend. Furthermore, incisions of the fundiform and suspensory ligaments facilitate this maneuver. With this technique, the blood supply of the penile skin is not interrupted and postoperative lymphedema, a difficult complication to deal with, is prevented. One major advantage is the preservation of the prepuce, giving a normal penile appearance and an excellent cosmetic result.
  
  
  CONCLUSIONS
  The method proposed here is simple and has no serious complications. It is suggested that this condition be treated in pre-school-aged children in order to prevent psychological impairment.
authors.affiliation: Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece. Electronic address: ivalis@otenet.gr.
authors.forename: I A
authors.initials: IA
authors.lastname: Valioulis
authors.affiliation: Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece. Electronic address: ignatios-kallergis2010@hotmail.com.
authors.forename: I C
authors.initials: IC
authors.lastname: Kallergis
authors.affiliation: Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece. Electronic address: denise@otenet.gr.
authors.forename: D C
authors.initials: DC
authors.lastname: Ioannidou
mesh_terms: D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000151:congenital / Q000601:surgery*; D010413:Penis / Q000002:abnormalities* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012611:Scrotum / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*