New surgical approach for buried penis with partial release of the penile suspensory system associated with fat transfer and suprapubic retraction.

[BACKGROUND] Adult acquired buried penis (AABP) is a condition of entrapment of the phallus resulting most commonly from obesity. This condition has a significant negative impact on the quality of life, including micturate difficulties, sexual dysfunction and recurrent infections. Many techniques exist to treat AABP; however, do not necessarily include a suspensory ligament release. The ligamentous system supporting the penis is widely called the "penile suspensory ligament" and is composed of four ligaments.

[OBJECTIVES] We wanted to explore the clinical outcomes on an exploratory patient cohort for penis-lengthening in patients with Grade 1 buried penis using a partial release of the penile suspensory system associated with fat transfer combined with a suprapubic retraction.

[METHODS] Under general anesthesia, an abdominal liposuction was performed, followed by a direct defatting of the pubic mons. Then the fundiform, the suspensory and the anterior part of the vertical dense ligaments were severed. Furthermore, several anchoring sutures were added and a retropulsion of the supra pubic area was performed. Finally, the purified fat was injected into the penile shaft in a superficial plane. Files from patients who underwent surgery for stage 1 buried penis between 2015 and 2020 were retrospectively reviewed.

[RESULTS] Twelve patients with a buried penis underwent a lengthening procedure. The mean augmentation in length was 100% [28.6-218.2] and a mean augmentation of 85.7% [18.2-216.7] in width.

[CONCLUSIONS] We described a safe and reproducible technique for penile augmentation in patients with a stage 1 AABP.

[LEVEL OF EVIDENCE] Level III, cohort analytic study.