Efficacy analysis of modified circumcision in the treatment of pediatric concealed penis.

Abstract

<h4>Background</h4>Standardized technique of concealed penis remains undefined due to the high incidence of postoperative complications. This study aimed to introduce a novel modified circumcision for pediatric concealed penis and evaluate its efficacy in reducing complications.<h4>Methods</h4>We conducted a retrospective study in patients with concealed penis in our center during 2013 to 2023. Our modified technique improved circumcision through penile degloving, selective penoscrotal angle reconstruction, and graded preservation of inner preputial lamina according to penile concealment severity. The study group (n=53) comprised two subgroups: subgroup 1 (n=20, mild/moderate cases) received modified circumcision with 5-9 mm inner preputial lamina preservation, whereas subgroup 2 (n=33, severe cases) underwent additional penoscrotal angle reconstruction with 10-20 mm inner preputial lamina preservation. The control group (n=64) received classic Devine technique. The therapeutic effect and complications were compared using the Chi-squared or Student's t-test.<h4>Results</h4>The study group demonstrated shorter operation time and lower incidences of preputial edema, preputial redundancy, and penile retraction (P<0.05). The study group achieved greater penile length above baseline skin level (BPL) (3.17±0.89 <i>vs.</i> 2.55±0.80 cm) and length gain (1.65±0.57 <i>vs.</i> 1.00±0.50 cm) compared to controls (P<0.001). Patient satisfaction scores (9.55±1.41 <i>vs.</i> 7.92±1.92) and satisfaction rate (96.2% <i>vs.</i> 64.1%) were significantly higher in the study group (P<0.001). The study group acquired excellent penile aesthetics, approximating the post-circumcision morphology. Subgroup comparisons revealed shorter operation time in subgroup 1 and similarly low complication rates and satisfactory penile aesthetics in subgroup 2.<h4>Conclusions</h4>The modified circumcision effectively treats concealed penis with minimal invasiveness, reduced complication risks, and improved penile aesthetic outcomes. It provides individualized treatment according to penile concealment severity.