Buried penis in morbidly obese patient: surgical technique of fat pad excision, malleable penile prosthesis insertion and penile split skin graft

Abstract Introduction Buried penis has a significant impact on quality of life affecting voiding and sexual function. Central and suprapubic deposition of adipose tissue related to obesity is a common cause. Objective This video shows the surgical approach of a complex case of buried penis managed with a suprapubic fat pad excision and simultaneous malleable penile prosthesis insertion. Methods We present a case of buried penis in a morbidly obese patient (BMI:43) with a history of two previous gastric bypass surgery and an apronectomy. affecting micturition and sexual function. A skin incision is made with a transverse incision at the level of the anterior superior iliac spine and a curvilinear inferior border. The apex of the inferior border should be approximately 2 finger breadth above the level of the penopubic junction. The incision is extended down to the rectus sheath and the spermatic cords at the lateral boundaries and the penile shaft at the midline are exposed. A malleable implant is inserted using the infrapubic approach and a split skin graft harvested to replace the unhealthy penile shaft skin. The dermis of the skin edges are secured to the rectus sheath with 0/0 vicryl sutures and the wound is closed in layers. Results Post-operative recovery was complicated by partial necrosis of the skin graft. At 3 months, the patient was able to stand to void and engage in sexual intercourse at 6 months. Conclusions The prevalence of obesity is increasing and in men, the presence of a suprapubic fat bad can result in a buried penis and affect voiding and sexual function. Although weight loss should be advised in the first instance, this may often not be enough. A combination of a suprapubic fat pad excision with malleable penile implantation and spit skin graft is a treatment option that can be considered. Disclosure No