Surgical treatment of postcircumcision trapped penis

Abstract

Background/purpose Trapped penis refers to a phallus that has become entrapped by a dense cicatricial scar usually following circumcision. It is associated with cosmetic, psychosocial, voiding, and hygienic complications and concerns. Prompt treatment is usually required to alleviate concerns and prevent complications. The treatment is essentially surgical. This prospective study was carried out to report the surgical management of cases of trapped penis, the necessary steps/procedures needed, and the outcome of surgical repair, and parent satisfaction.
Patients and methods Patients with postcircumcision trapped penis indicated for surgical treatment were evaluated and managed. Evaluation included the age of patients, duration from circumcision, presenting complaints, predisposing conditions, surgical techniques, skin adequacy, and complications. The techniques used included scar excision, degloving, dermopexy, corporopexy, and skin coverage. Skin coverage was achieved by simple closure, split thickness skin graft (STSG), or scrotal flaps. One or more of the above-mentioned techniques were used depending on the individual characteristics of every case. The cases were evaluated for early complications, parent/patient satisfaction (evaluated subjectively), and recurrence.
Results A total of 21 children were surgically managed during a 5-year period. The mean age at the time of correction was 28 months (range: 3–133 months). The most common presenting complaints were anxiety and hidden penis. The mean time between circumcision and presentation was 13.9 months (range: 1–117 months). The techniques used for repair included simple scar excision and skin closure in 17 patients, scrotal flap in one patient, and STSG in three patients. Dermopexy was added in seven patients, and corporopexy was added in four patients. Of the patients, six had buried penis, and one patient had megameatus intact prepuce. Parent/patient satisfaction was excellent to good in 95% of patients.
Conclusion Postcircumcision trapped penis should be treated promptly to alleviate complications and anxiety, and improve body image. The treatment is mainly surgical; conservative treatment can be tried in early and mild cases. Circumcision in the buried penis converts a minor procedure to a complicated one. Skin coverage after the release of the trapped penis is a challenge and multiple plans should be available. STSG is a good option for penile coverage. Associated conditions and predisposing factors can be addressed in the same operation. The knowledge and practice of circumcision need to be improved.