What are the benefits and harms of surgical management options for adult-acquired buried penis? A systematic review

Objectives To systematically review the literature to determine the benefits and harms of the surgical techniques used for the correction of adult-acquired buried penis (AABP). Materials and methods The systematic review was registered in the PROSPERO database (CRD42021267440) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The Pariser system was used to classify surgical procedures. Results In total, 170 studies were identified and screened, and 21 studies (570 patients) were included. In general, high-complexity reconstructive procedures (category > III) were performed, with split-thickness skin grafts for shaft reconstruction. The pooled mean operating time was 192.2 min and the mean estimated blood loss range was 57–326 mL. No intra-operative complications were recorded. The incidence of postoperative complications varied across studies (0–80.8%), with >Grade 4 complications reported in 3.1–3.7% of cases. Wound infection and genital lymphoedema were reported in 4.7–33% and 7.1– 60% of cases, respectively. The incidence of graft contracture and partial/total loss was 2.4–14.3% and 1.5–21%, respectively. The incidence of recurrence was not systematically reported and ranged from 5.2% to 13%. Postoperative evaluation of functional outcomes demonstrated significant improvements in sexual function, urinary function and cosmesis. Assessment of risk of bias demonstrated a high risk of bias across all studies. Conclusions Surgical management of AABP has a high incidence of complications but results in satisfactory outcomes, with significant improvement in patients’ quality of life. The high incidence of graft-related complications should be taken into account when counselling patients and AABP care should be centralized to high-volume centres.