The aim of the work to compare the outcomes of suspensory ligament fixation to the sub-dermis and dorsal tunica albuginea fixation in terms of success rate, need for auxiliary procedures, and complication rates in the buried penis.
Children under the age of 18 years diagnosed
Children with buried penis with parents seeking surgical treatment of this condition.
History of previous penile surgery.
Patients with micro-penis.
Patients with other congenital anomalies such as hypospadias, epispadias and cryptorchidism.
Uncontrolled bleeding diathesis or patient who isn't fit for general anesthesia.
Parallel
Group A: Suspensory ligament fixation
Procedure/SurgeryAll patients will receive a prophylactic antibiotic before beginning of the procedure. The operative area will be cleaned with 10% povidine iodine and draped in sterile manner. We will perform the procedure in the supine position. The technique consists of complete degloving of the penis with release of any tethering tissues and exposure of the suspensory ligament at the base of the penile shaft. The suspensory ligament is identified, and fixation suture is placed between the ligament and the deep subdermal layer of the suprapubic skin without involving the tunica albuginea. This suture is positioned to secure the penile base and maintain a stable penopubic angle, helping to prevent retraction. Care is taken to ensure appropriate depth and tension of the sutures to avoid over-tightening, followed by re-draping and closure of the skin. This will also be associated with placement of 2 fixation sutures at the penoscrotal junction to identify Penoscrotal angle.
Group B: Tunica albuginea fixation
Procedure/SurgeryAll patients will receive prophylactic antibiotics before the beginning of the procedure. Operative area will be cleaned with 10% povidone iodine and draped in sterile manner. We will perform the procedure in supine position, The technique consists of complete degloving of the penis and release of any tethering tissues, exposure of the base of the penile shaft. Sutures are then placed between the tunica albuginea on the dorsal aspect of the penile base and the deep dermal (subdermal) layer of the suprapubic skin in the direction of 3 and 9 o'clock to avoid the neurovascular bundle. These sutures are positioned symmetrically to secure the penile shaft in a fixed position relative to the overlying skin. Care is taken to place the sutures at an appropriate depth and tension, followed by re-draping and closure of the skin. This will also be associated with placement of 2 fixation sutures at the penoscrotal junction to identify penoscrotal angle.
Evaluate recurrence of buried penis (repair of buried penis)
Postoperative complications
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