Buried penis surgical treatment in children: Dorsal dartos flap VS. Fascia fixation. A retrospective cohort study

Published:January 06, 2022DOI:https://doi.org/10.1016/j.jpurol.2021.12.016



      Several surgical techniques for buried penis (BP) treatment have been described, although there is not a reference pattern for it. In our institution, we have traditionally performed penis fixation to Buck's fascia at 3 points. In 2014 we introduced a dorsal dartos flap technique, fixed at both sides of the penis base.


      To compare both techniques and their long-term outcomes.


      A retrospective cohort study was conducted on consecutive patients with BP who underwent surgery between 2010 and 2018. They were divided according to surgical technique performed: group A (fascia fixation) and B (dorsal dartos flap). Demographic variables, surgical time and postoperative complications were analyzed. Long-term cosmetic outcomes were evaluated through a telephone survey to patients parents.


      Thirty-five patients were included (16 group A; 19 group B). Median age at intervention was 9.7 years in group A, with no statistical differences with group B (7.3 years; p = 0.071). No statistically significant differences were observed in mean surgical time or postoperative complications between both groups. Cosmetic outcomes (Table 2) were significantly better in group B, which presented higher percentages of satisfaction with the outcomes (95% vs. 64%; p = 0.02) and age at intervention (89% vs. 59%; p = 0.032), higher perception of the procedure as “minimally invasive” (100% vs. 71%; p = 0.013) and higher recommendation rate of the intervention (95% vs. 57%; p = 0.029).


      Summary TableSatisfaction of patients' parents with long-term cosmetic results.
      YES/NO questions (%) Group A (n = 16) Group B (n = 19) P-value OR (CI 95%)
      Satisfaction with the cosmetic result 64% 95% 0.025 10.2 (1.3–98.2)
      Optimal consideration of the age at which the procedure was performed 57% 89% 0.032 6.37 (1.2–33.6)
      Perception of the procedure as “minimally invasive" 71% 100% 0.013
      Recommendation of the procedure to other patients affected by the same pathology 57% 95% 0.029 13.5 (1.7–131.2)
      Abbreviations: CI, confidence Interval. P < 0.05 was accepted as significant.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Brisson P.
        • Patel H.
        • Chan M.
        • Feins N.
        Penoplasty for buried penis in children: report of 50 cases.
        J Pediatr Surg. 2001; 36: 421-425
        • Maizels M.
        • Zaontz M.
        • Donovan J.
        • Bushnick P.N.
        • Firlit C.F.
        Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder.
        J Urol. 1986; 136: 268-271
        • Alter G.J.
        • Ehrlich R.M.
        A new technique for correction of the hidden penis in children and adults.
        J Urol. 1999; 161: 455-459
        • Cromie W.J.
        • Ritchey M.L.
        • Smith R.C.
        • Zagaja G.P.
        Anatomical alignment for the correction of buried penis.
        J Urol. 1998; 160: 1482-1484
        • Redman J.F.
        Buried penis: a congenital syndrome of a short penile shaft and a paucity of penile shaft skin.
        J Urol. 2005; 173: 1714-1717
        • King I.C.
        • Tahir A.
        • Ramanathan C.
        • Siddiqui H.
        Buried penis: evaluation of outcomes in children and adults, modification of a unified treatment algorithm, and review of the literature.
        ISRN Urol. 2013 Dec 29; 2013: 109349
        • Liu X.
        • He D.W.
        • Hua Y.
        • Zhang D.Y.
        • Wei G.H.
        Congenital completely buried penis in boys: anatomical basis and surgical technique.
        BJU Int. 2013; 112: 271-275
        • Spinoit A.F.
        • Van Praet C.
        • Groen L.A.
        • Van Laecke E.
        • Praet M.
        • Hoebeke P.
        Congenital penile pathology is associated with abnormal development of the dartos muscle: a prospective study of primary penile surgery at a tertiary referral center.
        J Urol. 2015; 193: 1620-1624
        • Boemers T.M.
        • De Jong T.P.
        The surgical correction of buried penis: a new technique.
        J Urol. 1995; 154: 550-552
        • Lee T.
        • Suh H.J.
        • Han J.U.
        Correcting congenital concealed penis: new pediatric surgical technique.
        Urology. 2005; 65: 789-792
        • Lei J.
        • Luo C.
        • Wang X.
        • Su X.
        A novel "six stitches" procedures for pediatric and adult buried penis.
        Int Braz J Urol. 2019; 45: 190-191
        • Rivas S.
        • Romero R.
        • Parente A.
        • Fanjul M.
        • Angulo J.M.
        Simplification of the surgical treatment of a hidden penis.
        Actas Urol Esp. 2011; 35: 310-314
        • Manasherova D.
        • Kozyrev G.
        • Gazimiev M.
        Buried penis surgical correction: midline incision rotation flaps.
        Urology. 2020; 138: 174-178
        • Spinoit A.F.
        • De Prycker S.
        • Groen L.A.
        • van Laecke E.
        • Hoebeke P.
        New surgical technique for the treatment of buried penis: results and comparison with a traditional technique in 75 patients.
        Urol Int. 2013; 91: 134-139
        • Liu F.
        • Lin T.
        • He D.
        • Wei G.
        • Liu J.
        • Liu X.
        • et al.
        New technique for the treatment of buried penis in children.
        Urology. 2016; 88: 166-169