A New Surgical Technique for the Treatment of Congenital Concealed Penis Based on Anatomical Finding

PURPOSE: Surgery is the first-line treatment for congenital concealed penis, but penile retraction in some cases is inevitable. The aim of the study was to investigate the anatomical and histological characteristics of penile fasciae, and describe a new technique for the correction of concealed penis. MATERIALS AND METHODS: The anatomical structures of penile fasciae were observed in 10 adult cadaveric penises. Penile tissue samples were stained with hematoxylin-eosin, Masson's trichrome and Weigert's resorcin-fuchsin, respectively. From January 2017 to May 2019, 78 patients with congenital concealed penis were treated with the new surgical technique. The median age was 14 years (range: 8-18 years). RESULTS: Dartos fascia had sub-layers. The superficial layer was a well-vascularized tissue which was composed of nonpolar collagen fibers intermixed with nerves and vessels. The deep layer was composed of transverse arrangement of collagen fibers and elastic fibers, and there were fewer venules and nerve fibers. Based on the finding, we performed anatomical resection of the deep layer of dartos fascia for correcting concealed penis. During the operation dartos fascia was separated into two layers, and a complete circular resection of the deep layer was made at the base of penis. Mean follow-up was 14 months. All of patients and their parents were satisfied with the outcomes. None of patients underwent postoperative penile retraction. CONCLUSIONS: The anatomical resection of the deep layer of dartos fascia for correcting concealed penis is technically easy, safe and effective. It provides a good cosmetic appearance and functional outcomes.