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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
First Online:
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Abstract

Objective

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

Methods

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.

Result

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).

Conclusion

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.

Keywords

Adult-acquired buried penis Complication Satisfaction Predictors Smoking 
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Notes

Funding

None.

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)

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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

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