title: Classification System for Individualized Treatment of Adult Buried Penis Syndrome.
abstract: BACKGROUND
  The authors present their experience with reconstructive strategies for men with various manifestations of adult buried penis syndrome, and propose a comprehensive anatomical classification system and treatment algorithm based on pathologic changes in the penile skin and involvement of neighboring abdominal and/or scrotal components.
  
  
  METHODS
  The authors reviewed all patients who underwent reconstruction of adult buried penis syndrome at their referral center between 2007 and 2015. Patients were stratified by location and severity of involved anatomical components. Procedures performed, demographics, comorbidities, and clinical outcomes were reviewed.
  
  
  RESULTS
  Fifty-six patients underwent reconstruction of buried penis at the authors' center from 2007 to 2015. All procedures began with a ventral penile release. If the uncovered penile skin was determined to be viable, a phalloplasty was performed by anchoring penoscrotal skin to the proximal shaft, and the ventral shaft skin defect was closed with scrotal flaps. In more complex patients with circumferential nonviable penile skin, the penile skin was completely excised and replaced with a split-thickness skin graft. Complex patients with severe abdominal lipodystrophy required adjacent tissue transfer. For cases of genital lymphedema, the procedure involved complete excision of the lymphedematous tissue, and primary closure with or without a split-thickness skin graft, also often involving the scrotum. The authors' overall success rate was 88 percent (49 of 56), defined as resolution of symptoms without the need for additional procedures.
  
  
  CONCLUSIONS
  Successful correction of adult buried penis often necessitates an interdisciplinary, multimodal approach.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas.|From the Departments of Urology and Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.affiliation: Dallas, Texas.|From the Departments of Urology and Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Isamu
authors.initials: I
authors.lastname: Tachibana
authors.affiliation: Dallas, Texas.|From the Departments of Urology and Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Siegel
authors.affiliation: Dallas, Texas.|From the Departments of Urology and Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Ronald
authors.initials: R
authors.lastname: Hoxworth
authors.affiliation: Dallas, Texas.|From the Departments of Urology and Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Scott
authors.affiliation: Dallas, Texas.|From the Departments of Urology and Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D000328:Adult; D000465:Algorithms; D006801:Humans; D008297:Male; D010413:Penis / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures; D013577:Syndrome; D016896:Treatment Outcome