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JU INSIGHT Surgical Outcomes and Prediction of Complications Following High-Complexity Buried Penis Reconstruction
By: Christopher J. Staniorski, MD, University of Pittsburgh Medical Center, Pennsylvania; John M. Myrga, MD, University of Pittsburgh Medical Center, Pennsylvania; Robin V. Vasan, MD, University of Pittsburgh Medical Center, Pennsylvania; Roger D. Klein, MD, PhD, University of Pittsburgh Medical Center, Pennsylvania; Paul J. Rusilko, DO, FACS, University of Pittsburgh Medical Center, Pennsylvania | Posted on: 27 Nov 2023
Staniorski CJ, Myrga JM, Vasan RV, Klein RD, Rusilko PJ. Surgical outcomes and prediction of complications following high-complexity buried penis reconstruction. J Urol. 2023;210(5):782-790.
Study Need and Importance
Surgical intervention for adult acquired buried penis has been shown to improve quality of life. However, small studies with varied techniques report high complication rates (up to 81%) and reburying rates (up to 75%). Large cohorts have not characterized outcomes in high-complexity repairs or investigated factors predicting complications.
What We Found
This study retrospectively reviewed a population of high-complexity buried penis reconstructions, including an escutcheonectomy and penile skin graft (n=103). We discovered that 50% of patients will have a complication within 90 days of surgery; however, 41% of patients experienced a low-grade (Clavien I or II) complication, commonly minor wound dehiscence or infection that can be managed on an outpatient basis. Only 3.9% required a revision of their repair for poor outcome at median follow-up of 11 months. Surgical factors, patient history, frailty, and socioeconomic status were evaluated as predictors of complications. Patients with 2 or more risk factors on the modified frailty index had a higher rate of complication (71% vs 41%, P = .01) and were 6 times more likely to experience a complication on multivariable logistic regression (OR 6.41, P = .005).
Limitations
This was a single-center, retrospective study, which may affect the generalizability of the results. The outcomes need to be confirmed by a future prospective study.
Interpretation for Patient Care
While complications are frequent following complex buried penis repair, many of these are low grade. Given the low revision rate, the objective success of this operation is likely higher than previously published in small cohorts. The obese population is frequently medically complex, which creates a challenge in preoperative planning. Frailty can be a metric used to identify patients who may benefit from optimization prior to surgery or a less extensive repair based on their most bothersome complaints (Figure).
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