How is surgery for buried penis and scrotal lymphedema done?

Surgery for buried penis and scrotal lymphedema is a complicated process. It is done after other less invasive treatments have been tried. These include weight loss in obese adult males or compression strategies for lymphedema. Surgery is often done by a team including both a urologist and plastic surgeon.

The surgery is done under general anesthesia and usually requires a hospital stay of 3 to 5 days. In overweight adult males, it may also include a procedure to remove fatty abdominal tissue.

The surgery usually begins with a catheter (thin, flexible tube) being inserted into the urethra to stabilize the penis and protect the urethra (tube that caries urine out of the body). The shaft of the penis is then separated from surrounding tissues. Infected or scarred tissue is removed at this point. Surgery can involve:

  • Detaching the ligament that attaches the base of the penis to the pubic bone
  • Suction lipectomy, or the removal of fat cells using surgical suction catheters inserted through tiny incisions
  • Panniculectomy, or the removal of the pannus (excess skin and fatty tissue that hangs down over the genitals and/or thighs)
  • Escutheonectomy, or the removal of the fat pad above the pubic area

Skin grafts are then done, if needed, to cover the penile shaft that has been separated from surrounding tissues. Skin for the graft is usually taken from the patient’s thigh. In patients with buried penis caused by scrotal lymphedema, skin grafts also may be needed. However, there is usually enough uninvolved skin to rebuild the scrotum without grafting.

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