Benign penile skin anomalies in children: a primer for pediatricians

Castagnetti, Marco; Leonard, Mike; Guerra, Luis; Esposito, Ciro; Cimador, Marcello

doi:10.1007/s12519-015-0015-5

Cited by 14 publications

(4 citation statements)

References 73 publications

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“…Although there is precedence in the literature advocating the use of dartos flaps for surgical repair in the correction of buried penis and penile torsion, its use has not yet been reported for use in the correction of CMP. 18,19 We believe this report to be the first ever to advocate the use of dartos flaps for the correction of CMP. We feel through our study and the results described that we have justified the claim that our modified technique using dartos flaps attains a consistently excellent penile shaft length postoperatively and corrects the persistent buried appearance so often encountered with other FIG.…”

Section: Discussionmentioning

confidence: 74%

Megaprepuce: A New Surgical Technique with Excellent Cosmetic and Functional Results

Wallace

Ashraf

2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Congenital megaprepuce (CMP) is a malformation consisting of redundant inner foreskin, normal penile shaft, and severe phimosis. The excess inner prepuce pushes the penile shaft deeper causing the appearance of a buried penis. We describe a novel surgical technique using dartos fascial flaps to reconstruct the prepuce giving excellent cosmetic and functional results. Patients and Methods: Penile reconstruction was performed by a single surgeon in 07 cases of CMP between January 2018 and December 2019. In all cases, the described surgical technique was used. Following surgery, cosmetic and functional outcomes were reviewed as well as the incidence of complications. The patients' ages ranged from 15 to 27 months (mean = 19). Mean hospital stay was 9 hours (range = 7-12). Operating time was between 50 and 85 minutes. Results: Postoperative appearance of the penis was satisfactory for all the parents in our group. Swelling of the penile shaft was seen in all of our patients but settled within one week of surgery. Scrotal hematoma was seen in only one of our patients, but that also did not need any intervention and settled spontaneously. During the followup period (mean = 14.5 months, range 6-24) no patient underwent revision surgery. In all our patients, the final appearance was of a circumcised penis. The final similarity to a normal circumcised penis was excellent in all of our patients. Correction of penoscrotal transposition was done in all patients achieving an elongated penile shaft and almost invisible postoperative scarring. Conclusion: Our modified surgical procedure to correct CMP is a safe and simple technique, providing good cosmetic results with the appearance of a standard circumcised penis. This also provides a good functional outcome with complication rate quite low. This technique is also easy to reproduce and teach compared with other complex procedures.

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Section: Discussionmentioning

confidence: 74%

Megaprepuce: A New Surgical Technique with Excellent Cosmetic and Functional Results

Wallace

Ashraf

2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…spectrum and are thought to result from incomplete closure of the genital or urethral folds; they can present anywhere from the urethral meatus, along the ventral penile shaft, or more proximally towards the scrotum. 2 Mucoid cysts are also primarily present on the ventral surface, though they occur more distally on the glans and originate from ectopic urethral mucosa. 7 Fortunately, penile cystic lesions are not suspected of having malignant potential, allowing observation as a potential management course if the patient is not bothered by the lesion.…”

Section: Key Messagesmentioning

confidence: 99%

“…However, in some instances, they may impair urination or sexual function or create psychological distress or cosmetic concerns for patients and families. 2 The majority of congenital preputial cysts are self-limited and may be observed for spontaneous resolution, though some may ultimately benefit from surgical intervention. 3 Herein, we present the first documented case of a newborn who on antenatal ultrasound was found to have a giant cystic structure of the distal penis, which was confirmed as a benign congenital cyst.…”

Section: Introductionmentioning

confidence: 99%

Case – Antenatal ultrasound diagnosis of a giant penile inclusion cyst

Newton¹,

Corbett

Koyle³

et al. 2023

CUAJ

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Newton et al Case: Antenatal US diagnosis of a giant penile inclusion cyst2 © 2023 Canadian Urological Association cystic structure at the distal, dorsal aspect of the foreskin just left of midline (Fig 1c). The foreskin was easily reducible. The meatus was orthotopic, and both testes were normally descended. Ultrasound revealed a mildly complex cystic structure at the tip of the penis with a difficult to visualize distal urethra (Fig 1d).After counseling, the family elected to proceed with observation. By history, the mass continued to enlarge before rupturing spontaneously at one month of age. The parents reported drainage of white fluid from the cyst. At 2 month follow-up, spontaneous rupture was confirmed, and the family elected to proceed with elective circumcision.At nine months of age, cyst excision and phalloplasty were performed. Upon initial dissection, the cyst was pedunculated (Fig 2b). The cyst and stalk were external to the corpora and urethra. Although the cyst was dorsal, the stalk appeared to connect to the urethra ventrally. It was excised and sent for pathologic analysis. A leak test was performed without evidence of communication between the stalk and the urethra. Retraction of the foreskin revealed 90-degree counterclockwise penile torsion. This was fully identified after the penis was degloved due to mass effect from the cystic structure (Fig 2c). On further evaluation, torsion was noted to be due to rotation of the left corporal body posterior to the spongiosum. The dartos fascia was fixed to the corporal bodies at the penoscrotal junction to correct the torsion and penile concealment. Subsequently, the dorsal foreskin was incised to the level of the mucosal collar, and the preputial flaps were rotated ventrally and approximated at the midline to recreate the median raphe. Finally, the skin was anastomosed to the mucosal collar to complete the phalloplasty (Fig 2d).At his six-week postoperative visit, incision sites were healing well with no evidence of recurrence, and he was voiding without issue (Fig 3). Final pathology demonstrated squamous epithelial lining and chronic inflammatory changes consistent with an inclusion cyst. The stalk contained urothelial lining. All specimens were benign (Fig 4). DISCUSSIONPenile cysts are uncommon genitourinary malformations that are often not detected until adolescence or adulthood and are hence acquired rather than congenital. 3 Such cysts are typically located on the ventral midline of the penis. Acquired (or false) cysts include preputial Epstein pearls, trichilemmal cysts, epidermal inclusion cysts, and smegma cysts. 4 Smegma cysts, or 'smegmomas', are the most common penile cystic lesion. They form due to an accumulation of smegma beneath an unretractable foreskin and are often yellow in color. 5 While smegma cysts typically occur secondary to physiologic adhesions present at birth, epidermal inclusions cysts typically form following penile surgeries, including circumcision and hypospadias repair. Epidermal inclusion cysts may also be congenital ...

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“…3 Most cases of <90° rotation are asymptomatic and a clinical diagnosis is made, but corrective surgery is carried out on the request of the family. 4 In cases where correction surgery is not performed in childhood, it can be carried out in adulthood for reasons such as coitus difficulty. 1 The Fisher technique is common for correcting torsion in infants and toddlers.…”

Section: Introductionmentioning

confidence: 99%

Using two “V” shaped flaps in penile torsion treatment

Mirsadeghi

Aghaii²,

Aghamir

2020

Journal of Clinical Urology

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Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.

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Benign penile skin anomalies in children: a primer for pediatricians

Cited by 14 publications

References 73 publications

Megaprepuce: A New Surgical Technique with Excellent Cosmetic and Functional Results

Megaprepuce: A New Surgical Technique with Excellent Cosmetic and Functional Results

Case – Antenatal ultrasound diagnosis of a giant penile inclusion cyst

Using two “V” shaped flaps in penile torsion treatment

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