Webbed penis

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Webbed penis
Other namesPenis palmatus, penoscrotal fusion
Webbed penis 01.jpg
Specialty Urology

Webbed penis also known as buried or concealed penis is an acquired or congenital condition in which the scrotal skin extends onto the ventral penile shaft. The penile shaft is buried in the scrotum or tethered to the scrotal midline by a fold or web of skin. The urethra and erectile bodies are usually normal. Webbed penis is usually asymptomatic, but the cosmetic appearance is often unacceptable. This condition may be corrected by surgical techniques. [1] [2] [3] [4]

Contents

In the congenital form, the deformity represents an abnormality of the attachment between the penis and the scrotum; the penis, the urethra, and the remainder of the scrotum typically are normal.

Webbed penis may also be acquired (iatrogenic) after circumcision or other penile surgery, resulting from excessive removal of ventral penile skin; the penis can retract into the scrotum, resulting in secondary phimosis (trapped penis).

Signs and symptoms

Since the penis does not protrude when a man has this disorder, his ability to pass urine when he is standing or to participate in sexual intercourse will be impaired.

Visible signs may include but are not limited to:

Cause

Webbed penis can be caused by various things such as:[ citation needed ]

Mechanism and pathophysiology

Concealed penis is due to a lack of skin or an inelasticity of the penile skin and a weak penile skin fixation or excessive suprapubic fat, the penile webbed is characterized by a ventral fold of skin that connects the distal shaft and a penoscrotum, and a penis which is tucked away with the scar tissue that exists.

Concealed penis is an unusual circumcision complication. The excision of excess preputial skin occurs, although inadequate internal preputial epithelium is cut out. The new preputial orifice is thus distal to the gland and pushes the penile shaft into the supra-pubic fat at the level of mons pubis. In these cases, the released shaft includes a skin graft or local flaps. The other probability of this mechanism is that, since the penis continues to shrink into the mons pubis, the healed scarred pre-utile opening gradually becomes subcutaneously stuck. In such cases, the released shaft needs no skin graft or local flaps. For both mechanisms, the preputial skin is inadequately excised, causing the preputial holes to be distal from the pulse, trapping the pulp when the procedure is complete. [6]

In relation to lymphedema – When the lymph system operates normally, the lymph circulates through a series of vessels and ducts throughout the body. It then returns to the bloodstream with lymph. A blocking or failure in the genital area of this system may lead to a lymphatic leak into the soft tissues surrounding the system.

In relation to obesity – Obesity is a general cause of adult acquired buried penis. There are some parallels with buried penis seen in infants, frequently associated with poor skin suspension, abnormal excess fat accumulation in the pubic region, penis webbing, or penis trapping due to scarring post-circumcision. Similarly, adult buried penis is often associated with a laxity of connective tissue between the dart fascia and the penis, allowing the penis to tunnel more closely through the pre-pubic skin due to "hypermobility." This is exacerbated by obesity and weight gain as the phallus is covered by the suprapubic fat pad. [7]

Diagnosis

Typically a physical examination may be used to diagnose a person with a buried penis. A doctor should be able to differentiate between buried penis and a tiny penis, known as micropenis. [8]

Treatment

Adults with a buried penis either deal with or are subject to weight loss services. Weight loss programs are however sluggish and frequently do not "unbury" the penis; in addition, bad urine hygiene can lead to soft tissue infection.[ citation needed ]

While the condition can resolve without intervention in young children, if infection is present, patients may ultimately need a definite reconstruction and urgent procedure. Surgeons who treat this disorder are either urologic or plastic surgeons. [9]

Operational options can include ligament separation between penis base and pubic bone; skin graft output to cover penis areas requiring additional skin; liposuction using catheters to suck out fat cells from the region around the penis from below the skin; abdominoplasty that removes excess skin and fat from the area; an escutheonectomy to remove a fat pad just above the pubic area; or a panniculectomy in which pannicles are extracted, excess tissues and skin that hangs on the genitals and thighs. [10]

A form of prevention for this condition could be avoiding getting a circumcision in order to avoid complications along the line. On the other hand, proper circumcision is a key factor in preventing this complication of circumcision. [11] This condition requires the liberation of the concealed penis by carefully widening the close preputial hole and optimizing the circumcision, depending upon the etiology and formation process, with or without skin reconstruction.

Prognosis

A person with a concealed penis will have a normal life expectancy. In the studies that have been performed, it is shown that there are no current known side effects post-op. However, a patient might have a slight edema for about a month or two. The only side effect would be an operation scar. [13]

Epidemiology

Webbed penis is considered to be a very uncommon condition, however, its prevalence is still unknown. Due to the fact that it occurs at birth, a high percentage of cases with the condition are found in young children. [14]

Research directions

Webbed penis is when the penis is partially or completely concealed beneath the scrotum or when there is excess skin or fat around the pubic area. Various research is being conducted on this condition: for example, Webbed penis: A new classification [15] is a study that was conducted to suggest an operative method that can be planned based of the severity of the webbing condition. Other research has tried to test the introduction of a modified surgical procedure for repairing a concealed penis and compared the efficacy and feasibility of modified repair with traditional repair. [16]

An interesting research study was done between the years 2010 and 2014 to test a new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. The research showed that the advanced musculocutaneous scrotal flap technique for correcting concealed penis is technically easy and safe and the surgical method provided patients with a good cosmetic appearance, functional outcomes, and excellent postoperative satisfaction grades. [17]

See also

Related Research Articles

<span class="mw-page-title-main">Glans penis</span> End of the penis

In male human anatomy, the glans penis, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and primary anatomical source of sexual pleasure. The glans penis is present in the male reproductive organs of humans and most mammals where it may appear smooth, spiny, elongated or divided. It is externally lined with mucosal tissue, which creates a smooth texture and glossy appearance. In humans, the glans is located over the distal ends of the corpora cavernosa and is a continuation of the corpus spongiosum of the penis. At the summit appears the urinary meatus and at the base forms the corona glandis. An elastic band of tissue, known as the frenulum, runs on its ventral surface. In men who are not circumcised, it is completely or partially covered by a fold of skin called the foreskin. In adults, the foreskin can generally be retracted over and past the glans manually or sometimes automatically during an erection.

<span class="mw-page-title-main">Foreskin restoration</span> Process to expand skin on the penis

Foreskin restoration is the process of expanding the skin on the penis to reconstruct an organ similar to the foreskin, which has been removed by circumcision or injury. Foreskin restoration is primarily accomplished by stretching the residual skin of the penis, but surgical methods also exist. Restoration creates a facsimile of the foreskin, but specialized tissues removed during circumcision cannot be reclaimed. Actual regeneration of the foreskin is experimental at this time. Some forms of restoration involve only partial regeneration in instances of a high-cut wherein the circumcisee feels that the circumciser removed too much skin and that there is not enough skin for erections to be comfortable.

<span class="mw-page-title-main">Penis enlargement</span> Technique aimed to increase the size of a human penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

<span class="mw-page-title-main">Paraphimosis</span> Medical condition

Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced. If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.

<span class="mw-page-title-main">Phimosis</span> Medical condition

Phimosis is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

<span class="mw-page-title-main">Hypospadias</span> Medical condition

Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location in the head of the penis. It is the second-most common birth abnormality of the male reproductive system, affecting about one of every 250 males at birth. Roughly 90% of cases are the less serious distal hypospadias, in which the urethral opening is on or near the head of the penis (glans). The remainder have proximal hypospadias, in which the meatus is all the way back on the shaft of the penis, near or within the scrotum. Shiny tissue that typically forms the urethra instead extends from the meatus to the tip of the glans; this tissue is called the urethral plate.

<span class="mw-page-title-main">Chordee</span> Medical condition

Chordee is a condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. The curvature is usually most obvious during erection, but resistance to straightening is often apparent in the flaccid state as well. In many cases but not all, chordee is associated with hypospadias. This is not the same condition as Peyronie's disease, which involves curvature of the shaft of the penis most commonly due to injury during adult life.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

<span class="mw-page-title-main">Vaginoplasty</span> Surgical procedure

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury. Labiaplasty, which alters the appearance of the vulva, can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Penile frenulum</span> Band of tissue under the glans penis connecting the foreskin to the vernal mucosa

The frenulum of the penis, often known simply as the frenulum or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa. In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection. In flaccid state it tightens to narrow the foreskin opening.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male intromittent organ that additionally serves as the urinary duct. The main parts are the root (radix); the body (corpus); and the epithelium of the penis including the shaft skin and the foreskin (prepuce) covering the glans penis. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The human male urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra traverses the corpus spongiosum, and its opening, the meatus, lies on the tip of the glans penis. It is a passage both for urination and ejaculation of semen.

<span class="mw-page-title-main">Corona of glans penis</span> Flare above the sulcus of the human male sex organ

The corona of glans penis or penis crown refers to the rounded projecting border or flare that forms at the base of the glans in human males. The corona overhangs a mucosal surface, known as the neck of the penis, which separates the shaft and the glans. The deep retro-glandular coronal sulcus forms between the corona and the neck of the penis. The two sides of the corona merge on the ventral midline forming the septum glandis. The circumference of the corona is richly innervated and is described as a highly erogenous area of the glans.

<span class="mw-page-title-main">Micropenis</span> Unusually small penis

A micropenis is an unusually small penis. A common criterion is a dorsal penile length of at least 2.5 standard deviations smaller than the mean human penis size A micropenis is stretched penile length less than 2.5 cm in term infants, 2.6 cm in one-year-old, 3.5 cm in five year old, 3.8 cm in ten year old, and 9.3 cm in adults. The condition is usually recognized shortly after birth. The term is most often used medically when the rest of the penis, scrotum, and perineum are without ambiguity, such as hypospadias. Micropenis incidence is about 1.5 in 10,000 male newborns in North America.

<span class="mw-page-title-main">Diphallia</span> Genital medical condition

Diphallia, penile duplication (PD), diphallic terata, or diphallasparatus, is an extremely rare developmental abnormality in which a male is born with two penises. The first reported case was by Johannes Jacob Wecker in 1609. Its occurrence is 1 in 5.5 million boys in the United States.

<span class="mw-page-title-main">Foreskin</span> Retractable fold of skin which covers and protects the glans of the penis

In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the glans by an elastic band of tissue, known as the frenulum. The outer skin of the foreskin meets with the inner preputial mucosa at the area of the mucocutaneous junction. The foreskin is mobile, fairly stretchable and sustains the glans in a moist environment. Except for humans, a similar structure, known as penile sheath, appears in the male sexual organs of all primates and the vast majority of mammals.

<span class="mw-page-title-main">Buried penis</span> Male congenital condition

Buried penis is a congenital or acquired condition in which the penis is partially or completely hidden below the surface of the skin. A buried penis can lead to urinary difficulties, poor hygiene, infection, and inhibition of normal sexual function.

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development and is normally included in an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam is conducted to detect various ailments, measure sexual development, or verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to uncircumcision, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual than an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

<span class="mw-page-title-main">Penile raphe</span> Line of tissue on the human penis

The penile raphe is a visible line or ridge of tissue that runs on the ventral side of the human penis beginning from the base of the shaft and ending in the prepuce. The line is typically darker than the rest of the shaft skin, even though its shape and pigmentation may vary among males. The penile raphe is part of a broader line in the male reproductive organs, that runs from the anus through the perineum and continues to the scrotum and penis, collectively referred to as median raphe.

References

  1. ↑ Abbate, B; Danti, DA; Pancani, S; Pampaloni, A (1994). "Congenital anomalies of the penis in children. A few consideration about 92 cases". Minerva Pediatr. 46 (4): 139–42. PMID   8084319.
  2. ↑ Bergeson, PS; Hopkin, RJ; Bailey Jr., RB; McGill, LC; Piatt, JP (1993). "The inconspicuous penis". Pediatrics. 92 (6): 794–9. doi:10.1542/peds.92.6.794. PMID   8233739. S2CID   19887297.
  3. ↑ Medina Lopez, RA; Campoy Martinez, P; Jimenez del Valle, U; Hernandez Soto, R; Ramirez Mendoza, A; Soltero Gonzalez, A (1999). "The webbed penis. A report of a new case". Arch Esp Urol. 52 (1): 68–9. PMID   10101890.
  4. ↑ Hara, M; Kanamori, S (1987). "A case of webbed penis". Hinyokika Kiyo. 33 (6): 951–2. PMID   3673843.
  5. ↑ Ho, Tammy S.; Gelman, Joel (August 2018). "Evaluation and management of adult acquired buried penis". Translational Andrology and Urology. 7 (4): 618–627. doi: 10.21037/tau.2018.05.06 . ISSN   2223-4691. PMC   6127540 . PMID   30211051.
  6. ↑ Cimador, Marcello; Catalano, Pieralba; Ortolano, Rita; Giuffrè, Mario (April 2015). "The inconspicuous penis in children". Nature Reviews Urology. 12 (4): 205–215. doi:10.1038/nrurol.2015.49. ISSN   1759-4820. PMID   25850928. S2CID   38525398.
  7. ↑ Ho, Tammy S.; Gelman, Joel (August 2018). "Evaluation and management of adult acquired buried penis". Translational Andrology and Urology. 7 (4): 618–627. doi: 10.21037/tau.2018.05.06 . ISSN   2223-4691. PMC   6127540 . PMID   30211051.
  8. ↑ "Concealed Penis | Ohio State Urology". wexnermedical.osu.edu. Retrieved 2020-11-12.
  9. ↑ "Results of A Simplified Technique for Buried Penis Repair" (PDF). 2015-07-24. Archived from the original (PDF) on 2015-07-24. Retrieved March 12, 2023.
  10. ↑ Elist, James J.; Baniqued, Matthew; Hosseini, Alireza; Wilson, Steven K. (May 2020). "Correction of retractile penis with subcutaneous soft silicone penile implant". International Journal of Impotence Research. 32 (3): 317–322. doi:10.1038/s41443-019-0174-3. ISSN   1476-5489. PMID   31383992. S2CID   199450704.
  11. ↑ Suliman, Mohamed taifour (2005). "Concealed penis in a 2-year-old boy: a rare complication of circumcision". Annals of Saudi Medicine. 25 (1): 56–57. doi:10.5144/0256-4947.2005.56. ISSN   0256-4947. PMC   6150566 . PMID   15822497.
  12. ↑ Anandan, Lavanya; Mohammed, Aza (2018). "Surgical management of buried penis in adults". Central European Journal of Urology. 71 (3): 346–352. doi:10.5173/ceju.2018.1676. ISSN   2080-4806. PMC   6202613 . PMID   30386659.
  13. ↑ Cheng, Gong; Liu, Bianjiang; Guan, Zhaolong; Huang, Yuan; Qin, Chao; Song, Ninghong; Wang, Zengjun (2015). "A modified surgical procedure for concealed penis". Canadian Urological Association Journal. 9 (9–10): E723–E726. doi:10.5489/cuaj.3028. ISSN   1911-6470. PMC   4662445 . PMID   26664507.
  14. ↑ Jul 27, The Journal of Urology A. New Surgical Technique for the Treatment of Congenital Concealed Penis Based on Anatomical Finding J. Urol 2020; Zhang, H.; Zhao, G.; Feng, G.; Han, H.; Li, H.; Xiao, K.; Song, Y.; MEDLINE®/PubMed®, J. Cui From. "New Surgical Technique for the Treatment of Congenital Concealed Penis". PracticeUpdate. Retrieved 2020-12-16.
  15. ↑ El Gohary, Mohamed Amin; El-Koutby, Montasser (2010). "Webbed penis: A new classification". Journal of Indian Association of Pediatric Surgeons. 15 (2): 50–2. doi: 10.4103/0971-9261.70637 . ISSN   0971-9261. PMC   2952775 . PMID   20975781.
  16. ↑ Chen, Yue-bing; Ding, Xian-fan; Luo, Chong; Yu, Shi-cheng; Yu, Yan-lan; Chen, Bi-de; Zhang, Zhi-gen; Li, Gong-hui (September 2012). "A new plastic surgical technique for adult congenital webbed penis". Journal of Zhejiang University. Science. B. 13 (9): 757–760. doi:10.1631/jzus.B1200117. ISSN   1673-1581. PMC   3437374 . PMID   22949367.
  17. ↑ Han, Dong-Seok; Jang, Hoon; Youn, Chang-Shik; Yuk, Seung-Mo (2015-06-19). "A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap". BMC Urology. 15 (1): 54. doi: 10.1186/s12894-015-0044-3 . ISSN   1471-2490. PMC   4471909 . PMID   26088081.
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