Objectives: To compare the efficacy of three surgical approaches for correcting severe concealed penis in pediatric patients.
Methods: We conducted a retrospective cohort analysis of 150 consecutive cases treated at our hospital from January 2020 through January 2023. Participants were stratified into three intervention groups: Group A (pedicled island flap transfer, n=50), Group B (modified Shiraki penile skin inlay, n=50), and Group C (scrotal skin advancement technique, n=50). Comparative parameters included operative duration, postoperative complications (scarring, infection, edema, and retraction), and penile shaft exposure measurements at 6-month follow-up.
Results: All procedures were completed without intraoperative neurovascular bundle injury or urethral complications. No cases exhibited persistent postoperative preputial edema or dysphoric erection. Demographic characteristics including mean age (4.2±1.3 years), body mass index percentile (78.4±12.6), and preoperative infection rates showed no intergroup differences (p>0.05). Significant variances emerged in operative duration (Group A: 98±15min vs Group C: 82±12min, p=0.017), postoperative penile length gain (Group A: 2.8±0.6cm vs Group B: 2.1±0.5cm, p<0.01), retraction rates (Group B: 14% vs Group A: 2%, p=0.03), and persistent edema incidence (Group B: 18% vs Group A: 4%, p=0.008).
Conclusion: While all three techniques effectively addressed severe concealed penis deformity, pedicled island flap reconstruction (Group A) and scrotal advancement plasty (Group C) demonstrated superior long-term outcomes in tissue viability and complication profiles. These approaches achieved significantly better phallic length preservation and lower reoperation rates compared to the modified Shiraki technique.
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