5/28/2023 0 Comments Webbed scrotumHowever, it will not be easy for inexperienced physicians to identify different types of concealed penis, and thus some patients may receive the unnecessary surgery or delayed treatment. The type of concealed penis is usually distinguished based on the experience of the physician. However, the identification of congenital concealed penis and obesity concealed penis still lacks auxiliary diagnostic indicators. Devine surgery and modified Devine surgery were often used for children with congenital concealed penis and showed good postoperative outcomes ( 10, 16). Surgical repair is still the primary treatment for concealed penis ( 15). As a result, these patients often suffer severe psychological distress, and their quality of life may be negatively affected, especially in terms of body image and psychology ( 12- 14). These anomalies are often accompanied by multiple urologic concerns in adulthood, including sexual dysfunction, voiding dysfunction, and health problems. However, reconstruction or surgery for the concealed penis will be delayed when the condition is mistakenly attributed to the patients’ obesity.Ĭoncealed penis not only affects the appearance of males, but long-term penile concealment also affects its structure and function ( 11). For concealed penis caused by obesity, the penis may gradually return to normal after weight loss. Excessive suprapubic fat is also the cause of concealed penis in children ( 10). However, congenital concealed penis is easily confused with phimosis and obesity-caused concealed penis (named obesity concealed penis in this study), especially for non-clinical personnel or inexperienced physicians. Trapped penis and webbed penis are easier to distinguish from another abnormal penis. In general, an experienced physician can diagnose the type of abnormal penis by careful observation and provide the appropriate treatment. Most patients or these parents will seek medical consultation for their abnormal penis appearance. These abnormal penis types are more common in infants and prepubertal boys. Webbed penis is caused by the scrotal skin extending to the abdominal penis, resulting in the penis buried in the scrotum or tethered to the scrotal midline by a fold or web of skin. Trapped penis refers to the penis wrapped by dense cicatricial scar, usually caused by excessive circumcision. Buried penis is a typical-sized penis that is enclosed in the fat pad due to lack of skin attached to the shaft. In contrast, concealed penis is normal in size but looks small, and is concealed in the subcutaneous tissue. A micropenis is characterized by a small penis with a median raphe, glans and no hypospadias. Shirley Tsang demonstrated that micropenis is different from concealed penises, which was further categorized as buried penis, webbed penis and trapped penis ( 9). ( 6) described a classification of 4 subtypes, including buried penis, trapped penis, webbed penis and micropenis, which are helpful for understanding pathophysiology ( 7, 8). Based on the mechanism of concealment, Maizels et al. In 1977, Crawford described the terms of concealed penis, buried penis and webbed penis ( 5). A literature search indicated that there are several classifications of concealed penis. The causes of concealed penis mainly include inadequate outer penile skin, narrow opening of the prepuce, hypoplasia of the penile sarcolemma, lack of elasticity, abnormal attachment of the sarcolemma to deep tissues, inadequate subcutaneous attachment to Buck’s fascia, fat accumulation above the pubic arch, and a tight phimosis ( 1- 4). BackgroundĪ concealed penis is a congenital anomaly that affects the appearance and function of genitalia in children and adults. In addition, Experienced physicians teaching new physicians/students, can also use this as an auxiliary explanation.ĭifferential Diagnosis Phimosis Congenital Concealed Penis Obesity Concealed Penis Buried Penis 1. This evaluation system can provide an auxiliary way to help the diagnosis of different types of concealed penis in children and provide a basis for subsequent treatment.
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