Buried penis is a growing concern among the rising obesity pandemic. In this study, we modified the surgical technique of suprapubic lipectomy. We placed tacking sutures between the penile hypodermis and pubic periosteum to maintain the acquired length of the penis.
Donatucci and Ritter conducted previous trials of suprapubic lipectomy, but patients underwent only suspensory ligament release. The disadvantage of the aforesaid technique was that the peno-pubic junction surroundings were not stabilized, in addition to the unsustainable new penile length 3. Alter and Ehrlich were the first to characterize the pathophysiology underlying concealed penis, and they performed a similar surgical procedure involving dermo-lipectomy from the abdominal crease in cases of only excessive skin4.
Shaeer hypothesized that the Alter and Ehrlich technique had the disadvantage of re-swallowing the penis into the neighboring skin and adipose tissues. Consequently, he devised a similar technique involving the removal of penile skin and subcutaneous fat immediately surrounding the penile base, as well as the release of the suspensory ligaments. Alter and Ehrlich did not use local flaps and only treated patients with excess skin. Contrary to Shaeer, who utilized an abdominal skin flap to conceal any excess penile shaft length after skin and fat excision 5.
The benefit of tacking the penis was preventing the penile from swallowing back and resurfacing, which was the disadvantage of older techniques, as discussed in multiple previous studies 4, 6–9. Our technique was similar to Shaeer's technique. However, this approach was distinct from ours in that they used tacking sutures between the penis and abdominal tissue, not the pubic bone. They also removed tissues immediately surrounding the penile base, not two fingers breadth proximal to it. We approximated the incision lines without tension, maximizing the visible penile shaft without requiring a local flap.
We used a measurable method to estimate the operative results by measuring the penile length at various time intervals, and validated questionnaires were used to subjectively measure patient satisfaction. This is in contrast to Donatucci and Ritter, who used less objective methodology for their assessment3. We did not use a local abdominal flap because we adhered to Alter and Ehrlich's more traditional technique, which requires the availability of extra skin for coverage and the tension-free approximation of incision lines4. Avoiding flaps simplified the technique and shortened the mean operating time to 51. 7 ± 7.6 minutes.
The small number of patients and the three-month follow-up period are our limitations. Adding flaps to patients who need them necessitates modifying the operation and studying its outcomes.