Presentation Authors: Melanie Aube-Peterkin, Montreal, Canada, Michael Chua*, Jessica DeLong, Jeremy Tonkin, David Gilbert, Kurt McCammon, Ramon Virasoro, Norfolk, VA
Introduction: Surgical correction of adult acquired buried penis (AABP) typically results in excellent outcomes. However, complication rates are high. Our objective is to report our institutional data on surgical treatment of AABP, to determine predictors for surgical complications, and asses patient satisfaction.
Methods: A retrospective review of all patients diagnosed with AABP who underwent surgical treatment at Eastern Virginia Medical School from January 2013 to December 2017 was performed. Patient demographics, surgical, and post-operative data were extracted. Univariate and multivariate regression analyses were performed to identify predictors for surgical complications. Receiver Operator Characteristics with Youden&[prime]s index was used to determine optimal cut-off values for continuous variables to predict complications. Patients&[prime] post-operative satisfaction was likewise assessed for factors such as successful outcome (defined as an absence of recurrence of buried penis and no repeat surgery for buried penis), post-operative erection quality and complications related to the surgery.
Results: A total of 24 patients aged 61.5 Â± 9.33 years old with a mean follow-up period of 20.5 Â± 20.91 months were included for analysis. Overall success was 21 (87.5%). Complications occurred in 15 (62.5%) patients with 7 (29%) Clavien-Dindo (C-D) category 3 events. Based on univariate and multivariate regression analyses, perioperative BMI â‰¥ 40 (HR 25; 95%CI 1.45 to 431.810) and tobacco smoking (HR 14.6; 95%CI 1.15 to 199.98) were identified as independent predictors of overall complications. Concomitant performance of abdominal panniculectomy was associated with morbidity C-D category 3 (HR 28; 95%CI 2.4 to 326.74) complications. Patient satisfaction was strongly associated with surgical success (p < 0.0001), post-operative erection (p < 0.027) and absence of surgical morbidity that needed further surgical intervention (p=0.032).
Conclusions: Our experience showed that surgical management of AABP has a high success, albeit with significant risk of post-operative complications. The independent predictors for overall complication included perioperative BMIâ‰¥ 40 and tobacco smoking. Abdominal panniculectomy may lead to a higher incidence of C-D category 3 morbidity. AABP surgical management success when defined according to post-procedural appearance and good post-operative erection could translate to patient satisfaction; however, morbidity that requires further surgical intervention may also affect overall patient satisfaction. Peri-operative counselling is important to give the patient realistic expectations.