title: Severe forms of concealed penis without hypospadias: Surgical strategies.
abstract: BACKGROUND
  Concealed penis (CP) may vary in severity and includes megaprepuce (MP) as a variant. Many different surgical strategies have been described in order to maximize penile exposure and to deal with skin deficiency. We describe the strategies that we use to overcome technical problems in severe cases of CP.
  
  
  METHODS
  Six consecutive cases of severe CP (including 3 with MP) were treated in a 2-year period between January 2011 and April 2013. These patients were treated using extensive degloving, removal of dysplastic dartos, Alexander's preputial flap, scrotal flaps and skin grafts. Three patients had been previously circumcised. Cases associated with hypospadias, obesity, disorders of sexual differentiation and micropenises were excluded.
  
  
  RESULTS
  All six patients attained good results, with good exposure of the penis, ability to void standing with a well-directed flow and reasonable esthetic results. A technical algorithm for the treatment of primary or recurring cases of CP is proposed.
  
  
  CONCLUSIONS
  Alexander' s distally based ventral preputial flap is a useful technical resource to treat MP cases. Free skin grafts and/or laterally based scrotal flaps may be used to cover the penis after release in severe cases of CP.
authors.affiliation: Department of Surgery/Pediatric Surgery and Urology, Antonio Pedro University Hospital Fluminense Federal University, Rio de Janeiro, Brazil ; Department of Pediatric Surgery and Urology, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
authors.forename: Lisieux Eyer
authors.initials: LE
authors.lastname: de Jesus
authors.affiliation: Department of Pediatric Surgery and Urology, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
authors.forename: Samuel
authors.initials: S
authors.lastname: Dekermacher
authors.affiliation: Department of Pediatric Surgery and Urology, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
authors.forename: Kleber M
authors.initials: KM
authors.lastname: Anderson
keywords: Concealed penis; megaprepuce; trapped penis