Buried penis surgical treatment in children: Dorsal dartos flap VS. Fascia fixation. A retrospective cohort study.

INTRODUCTION: Several surgical techniques for buried penis (BP) treatment have been described, although there is not a reference pattern for it. In our institution, we have traditionally performed penis fixation to Buck's fascia at 3 points. In 2014 we introduced a dorsal dartos flap technique, fixed at both sides of the penis base.

OBJETIVE: To compare both techniques and their long-term outcomes.

METHODS: A retrospective cohort study was conducted on consecutive patients with BP who underwent surgery between 2010 and 2018. They were divided according to surgical technique performed: group A (fascia fixation) and B (dorsal dartos flap). Demographic variables, surgical time and postoperative complications were analyzed. Long-term cosmetic outcomes were evaluated through a telephone survey to patients parents.

RESULTS: Thirty-five patients were included (16 group A; 19 group B). Median age at intervention was 9.7 years in group A, with no statistical differences with group B (7.3 years; p = 0.071). No statistically significant differences were observed in mean surgical time or postoperative complications between both groups. Cosmetic outcomes (Table 2) were significantly better in group B, which presented higher percentages of satisfaction with the outcomes (95% vs. 64%; p = 0.02) and age at intervention (89% vs. 59%; p = 0.032), higher perception of the procedure as "minimally invasive" (100% vs. 71%; p = 0.013) and higher recommendation rate of the intervention (95% vs. 57%; p = 0.029).

CONCLUSIONS: Dorsal dartos flap is a reproducible, minimally invasive technique with minimal adverse effects and satisfactory long-term results. It has fewer postoperative complications and more satisfactory cosmetic results compared to fascia fixation.