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JU INSIGHT: The Lived Experience of Patients with Adult Acquired Buried Penis
By: Gregory M. Amend, MD; Jordan T. Holler, MD, MPH; Michael J. Sadighian, MD, MAS, MSc; Natalie Rios, BS; Nizar Hakam, MBBS; Behnam Nabavizadeh, MD; Anthony Enriquez, BA; Nathan Shaw, MD; Alex J. Vanni, MD; Lee Zhao, MD; Bradley A. Erickson, MD; Jill C. Buckley, MD; Benjamin N. Breyer, MD, MAS | Posted on: 01 Aug 2022
Amend GM, Holler JT, Sadighian MJ et al: The lived experience of patients with adult acquired buried penis. J Urol 2022; 208: 396.
Study Need and Importance
Adult acquired buried penis (AABP) is a syndrome of penile entrapment associated with obesity. Given the obesity epidemic, this is a disease of increasing importance. We describe the lived experience of adults with AABP though a thematic analysis in combination with quantitative survey instruments to examine the challenges that these patients face and the impacts of surgery.
What We Found
We enrolled 20 patients; 11 had undergone surgical treatment for AABP. The most common themes were problems with urinary and sexual function. Negative impacts on social life, relationships and mental health were also reported. Patients who underwent surgery demonstrated improvement in urinary and sexual function as well as psychosocial health (see Table). Access to reconstructive care was a significant issue for these patients, including insurance coverage, availability of services and knowledge gaps among the referring medical community. Specifically, patients struggled to find providers who were able to direct them to a reconstructive urologist, being told to lose weight as a solution to their complaints. Conversely, we found that weight loss did not improve the outcome of any patient.
Table. Common issues in buried penis patients (preoperative vs postoperative)
| Theme | Issues before Surgery? (20 pts) |
Discussed Improvement after Surgery? (11 pts) |
||
|---|---|---|---|---|
| No. | % | No. | % | |
| Urinary issues | 19 | 95 | 9 | 82 |
| Sexual function issues | 19 | 95 | 8 | 73 |
| Impacting social life | 16 | 80 | 6 | 55 |
| Hygiene issues | 14 | 70 | 7 | 64 |
| Poor mental health | 11 | 55 | 6 | 55 |
| Infections | 9 | 45 | 2 | 18 |
| Relationship issues | 8 | 40 | 1 | 9 |
| Cosmesis issues | 6 | 30 | 0 | 0 |
| Physical issues | 0 | |||
| Mobility | 6 | 30 | 2 | 18 |
| Chronic pain | 5 | 25 | 0 | 0 |
| Livelihood | 2 | 10 | 0 | 0 |
Limitations
Outcomes were self-reported and therefore subject to confounding with comorbidities, which can alter the patient’s perception of his surgical result. Furthermore, we were unable to perform 2 separate interviews (preoperative and postoperative) for any single patient. As a result, our quantitative data are unable to provide longitudinal insight into an individual’s experience before and after surgery.
Interpretation for Patient Care
When a successful repair is performed, this can significantly improve the hygienic, urinary and sexual function of the patient, as well as lead to improvements in mental and social health. While this condition is often associated with significant weight gain, it is an irreversible process that requires complex surgical reconstruction and does not improve with weight loss.