Predictors of surgical complications and evaluation of outcomes after surgical correction of adult-acquired buried penis

  • Mélanie Aubé
  • Michael Chua
  • Jessica DeLong
  • Kurt McCammon
  • Jeremy Tonkin
  • David Gilbert
  • Ramón VirasoroEmail author
Urology - Original Paper



To determine predictors for surgical complications and assess patient satisfaction after surgical treatment of Adult-Acquired Buried Penis (AABP).


A retrospective review was performed on all patients diagnosed with AABP who underwent surgical treatment at a single institution from January 2013-December 2017. Patient demographics and peri-operative data were extracted. Univariate and multivariate regression analyses were performed to identify predictors for surgical complications. Patients’ post-operative satisfaction was likewise assessed for factors such as successful outcome, post-operative erection quality, and complications related to the surgery.


Twenty-four patients of median age 61.5 years (IQR 54–67) with median follow-up of 12 months (IQR 3.25–29) were included. Overall success was 87.5% (21/24). Complications occurred in 15 (62.5%) patients with 7 (29%) Clavien–Dindo category ≥ 3. Based on regression analyses, body mass index (BMI) ≥ 40 (HR 25; 95% CI 1.45–431.81) and tobacco smoking (HR 14.6; 95% CI 1.15–199.98) were identified as independent predictors of overall complications. Concomitant performance of abdominal panniculectomy was associated with Clavien–Dindo category ≥ 3 (HR 28; 95% CI 2.4–326.74) complications. Patient satisfaction was associated with surgical success (p < 0.0001), post-operative erection (p < 0.027), and absence of surgical morbidity that needed further surgical intervention (p = 0.032).


Surgical management of AABP following an individualized algorithm results in a high success rate but also in relatively high procedure-related morbidity. Peri-operative BMI ≥ 40 and tobacco smoking have higher odds for overall complication occurrence, while concomitant abdominal panniculectomy results in more occurrence of Clavien–Dindo category ≥ 3 morbidities. Patient’s eventual satisfaction correlates well with surgical success, post-procedural erection condition, and lack of Clavien–Dindo ≥ 3 morbidity.


Adult-acquired buried penis Complication Satisfaction Predictors Smoking 




Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Supplementary material

11255_2019_2347_MOESM1_ESM.docx (665 kb)
Supplementary Fig. 1. For morbidly obese patients with significant abdominal adiposity, an abdominal panniculectomy may be performed concomitantly with the help of a plastic surgeon. Appropriate use of drains to prevent post-operative hematoma and seroma is essential. (DOCX 665 kb)
11255_2019_2347_MOESM2_ESM.docx (181 kb)
Supplementary Fig. 2. Dressing option of placing a vacuum assisted closure (V.A.C.®) dressing around the penile shaft, using a WhiteFoam™ sponge. V.A.C. ® is set to 125 mmHg continuous suction. (DOCX 181 kb)
11255_2019_2347_MOESM3_ESM.docx (23 kb)
Supplementary Fig. 3. Receiver Operating Characteristics determined area under the curve and determination of Youden’s index for highest peri-operative BMI cut-off for overall complication occurrence. (DOCX 22 kb)
11255_2019_2347_MOESM4_ESM.docx (16 kb)
Supplementary material 4 (DOCX 15 kb)


  1. 1.
    Theisen KM, Fuller TW, Rusilko P (2018) Surgical management of adult-acquired buried penis: impact on urinary and sexual quality of life outcomes. Urology 116:180–184. CrossRefPubMedGoogle Scholar
  2. 2.
    Rybak J, Larsen S, Yu M, Levine LA (2014) Single center outcomes after reconstructive surgical correction of adult acquired buried penis: measurements of erectile function, depression, and quality of life. J Sex Med 11(4):1806–1891CrossRefGoogle Scholar
  3. 3.
    Hughes D, Perez E, Garcia R et al (2016) Sexual and overall quality of life improvements after surgical correction of “buried penis”. Ann Plast Surg 76(5):532–535CrossRefGoogle Scholar
  4. 4.
    Tausch T, Tahibana I, Siegel J et al (2016) Classification system for individualized treatment of adult buried penis syndrome. Plast Reconstr Surg 138(3):703–711CrossRefGoogle Scholar
  5. 5.
    Wisenbaugh E, Moskowitz D, Gelman J (2018) Reconstruction of massive localized lymphedema of the scrotum: results, complications, and quality of life improvement. Urology 112:176–180CrossRefGoogle Scholar
  6. 6.
    Voznesensky MA, Lawrence WT, Keither JN et al (2017) Patient-reported social, psychological, and urologic outcomes after adult buried penis repair. Urology 103:240–244CrossRefGoogle Scholar
  7. 7.
    Hampson LA, Muncey W, Chung PH et al (2017) Surgical and functional outcomes following buried penis repair with limited panniculectomy and split-thickness skin graft. Urology. 110:234–238CrossRefGoogle Scholar
  8. 8.
    Tang S, Kamat D, Santucci R (2008) Modern management of adult-acquired buried penis. Urology 72(1):124–127CrossRefGoogle Scholar
  9. 9.
    Anandan L, Mohammed A (2018) Surgical management of buried penis in adults. Cent Eur J Urol 71(3):346–352. CrossRefGoogle Scholar
  10. 10.
    Ho TS, Gelman J (2018) Evaluation and management of adult acquired buried penis. Transl Androl Urol 7(4):618–627. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Benchimol EI, Smeeth L, Guttmann A, Harron K, Hemkens LG, Moher D et al (2016) The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. Z Evid Fortbild Qual Gesundhwes. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Pariser JJ, Soto-Aviles OE, Miller B, Husainat M, Santucci RA (2018) A simplified adult acquired buried penis repair classification system with an analysis of perioperative complications and urethral stricture disease. Urology 120:248–252. CrossRefPubMedGoogle Scholar
  13. 13.
    Jun MS, Gallegos MA, Santucci RA (2018) Contemporary management of adult-acquired buried penis. BJU Int 122(4):713–715. CrossRefPubMedGoogle Scholar
  14. 14.
    Erpelding SG, Hopkins M, Dugan A, Liau JY, Gupta S (2018) Outpatient surgical management for acquired buried penis. Urology. CrossRefPubMedGoogle Scholar
  15. 15.
    Nolan MB, Martin DP, Thompson R, Schroeder DR, Hanson AC, Warner DO (2017) Association between smoking status, preoperative exhaled carbon monoxide levels, and postoperative surgical site infection in patients undergoing elective surgery. JAMA Surg 152(5):476–483. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kong L, Liu Z, Meng F, Shen Y (2017) Smoking and risk of surgical site infection after spinal surgery: a systematic review and meta-analysis. Surg Infect (Larchmt) 18(2):206–214. CrossRefGoogle Scholar
  17. 17.
    Warner DO (2005) Helping surgical patients quit smoking: why, when, and how. Anesth Analg 101(2):481–487CrossRefGoogle Scholar
  18. 18.
    Xiang J, Wang S, He Y, Xu L, Zhang S, Tang Z (2019) reasonable glycemic control would help wound healing during the treatment of diabetic foot ulcers. Diabetes Ther 10(1):95–105. CrossRefPubMedGoogle Scholar
  19. 19.
    Christman AL, Selvin E, Margolis DJ, Lazarus GS, Garza LA (2011) Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol 131(10):2121–2127. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Mélanie Aubé
    • 1
  • Michael Chua
    • 2
  • Jessica DeLong
    • 2
  • Kurt McCammon
    • 2
  • Jeremy Tonkin
    • 2
  • David Gilbert
    • 3
  • Ramón Virasoro
    • 2
    Email author
  1. 1.Department of UrologyMcGill University Health CenterMontrealCanada
  2. 2.Department of UrologyEastern Virginia Medical SchoolNorfolkUSA
  3. 3.Department of Plastic SurgeryEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations