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PREOPERATIVE DIAGNOSIS: Penile concealment.
POSTOPERATIVE DIAGNOSIS: Penile concealment.
PROCEDURE PERFORMED: Correction of penile concealment.
ANESTHESIA: General endotracheal and caudal block.
ESTIMATED BLOOD LOSS: Negligible.
FINDINGS: Paucity of penile skin.
INDICATION FOR OPERATION: The patient is a 12-month-old male with a history of circumcision soon after birth who presents with penile concealment. He has developed some mild preputial adhesions which have been unresponsive to medical therapy.
PROCEDURE IN DETAIL: After informed consent was obtained, the patient was brought to the operating suite and placed supine on the operating room table. General endotracheal anesthesia was induced. The patient was turned to the lateral position and a caudal block was performed. The patient was returned to the supine position. The lower abdomen and perioscrotal region were sterilely prepped and draped in the usual manner. The gland adhesions were manually reduced. A glans retraction suture was placed. A scrotal raphe retraction suture was also placed. An incision was made on the mucosal surface circumferentially creating a mucosal collar. A ventral raphe incision was carried down to the scrotum. The penile skin was then degloved from the shaft circumferentially. This dissection was carried down to the pubis dorsally and to the scrotum ventrally. Adherent Dartos was dissected from the corporal bodies ventrally. After achieving penile length with extensive bulbar dissection, the Dartos fascia was approximated in the corporal bodies ventrally with 5-0 clear nylon suture on either side into the corporal bodies. Attention was then turned to reconfiguring the penopabic angle. Again, the Scarpas fascia was approximated to the corporal bodies with 5-0 clear nylon suture on either side. A penile block was performed at this time. After recreating the penopubic and penoscrotal angle, attention was then turned to the redistribution of the penile skin. Given the paucity of penile skin, care was taken not to distribute it discordantly. The dorsal skin was divided in the midline. It was then reapproximated to the mucosal collar at the 12:00 position with a 7-0 Vicryl suture. The mucosal collar, which had been created earlier was trimmed in the midline and approximated with running 7-0 Vicryl. The resultant penile skin flaps were then brought around ventrally. The skin flaps were trimmed in midline. The penile raphe was then recreated with a running 7-0 Vicryl suture. The penile skin was then approximated to the mucosal collar ventrally at the 6:00 positron with interrupted 7-0 Vicryl suture. The excess skin was trimmed on either side and then the penile skin was approximated to the mucosal collar circumferentially with a running 7-0 Vicryl suture. Upon completion of this, the patient's bladder was drained with a #8 French sugar Firlit catheter, which was subsequently removed. A complex penile dressing was placed. This was comprised of Owens gauze soaked in Benzoin and wrapped around the penis, secured with Coban wrapped around the penis, which was secured with Transpore tape. The patient was awakened from general anesthesia. He was transferred to the PACU in stable condition.
POSTOPERATIVE DIAGNOSIS: Penile concealment.
PROCEDURE PERFORMED: Correction of penile concealment.
ANESTHESIA: General endotracheal and caudal block.
ESTIMATED BLOOD LOSS: Negligible.
FINDINGS: Paucity of penile skin.
INDICATION FOR OPERATION: The patient is a 12-month-old male with a history of circumcision soon after birth who presents with penile concealment. He has developed some mild preputial adhesions which have been unresponsive to medical therapy.
PROCEDURE IN DETAIL: After informed consent was obtained, the patient was brought to the operating suite and placed supine on the operating room table. General endotracheal anesthesia was induced. The patient was turned to the lateral position and a caudal block was performed. The patient was returned to the supine position. The lower abdomen and perioscrotal region were sterilely prepped and draped in the usual manner. The gland adhesions were manually reduced. A glans retraction suture was placed. A scrotal raphe retraction suture was also placed. An incision was made on the mucosal surface circumferentially creating a mucosal collar. A ventral raphe incision was carried down to the scrotum. The penile skin was then degloved from the shaft circumferentially. This dissection was carried down to the pubis dorsally and to the scrotum ventrally. Adherent Dartos was dissected from the corporal bodies ventrally. After achieving penile length with extensive bulbar dissection, the Dartos fascia was approximated in the corporal bodies ventrally with 5-0 clear nylon suture on either side into the corporal bodies. Attention was then turned to reconfiguring the penopabic angle. Again, the Scarpas fascia was approximated to the corporal bodies with 5-0 clear nylon suture on either side. A penile block was performed at this time. After recreating the penopubic and penoscrotal angle, attention was then turned to the redistribution of the penile skin. Given the paucity of penile skin, care was taken not to distribute it discordantly. The dorsal skin was divided in the midline. It was then reapproximated to the mucosal collar at the 12:00 position with a 7-0 Vicryl suture. The mucosal collar, which had been created earlier was trimmed in the midline and approximated with running 7-0 Vicryl. The resultant penile skin flaps were then brought around ventrally. The skin flaps were trimmed in midline. The penile raphe was then recreated with a running 7-0 Vicryl suture. The penile skin was then approximated to the mucosal collar ventrally at the 6:00 positron with interrupted 7-0 Vicryl suture. The excess skin was trimmed on either side and then the penile skin was approximated to the mucosal collar circumferentially with a running 7-0 Vicryl suture. Upon completion of this, the patient's bladder was drained with a #8 French sugar Firlit catheter, which was subsequently removed. A complex penile dressing was placed. This was comprised of Owens gauze soaked in Benzoin and wrapped around the penis, secured with Coban wrapped around the penis, which was secured with Transpore tape. The patient was awakened from general anesthesia. He was transferred to the PACU in stable condition.