"Although subtly different, we consider the inconspicuous, concealed, hidden or webbed penis as minor variations of the same entity. All occur due to minor anomalies of the preputial ring. Specifically, the webbed penis represents an encroachment of the scrotal tissue onto the ventral portion of the penis. This condition results in considerable shortening of the ventral penile shaft skin compared with the dorsal skin. This can occur in two forms: (1) narrowing of the preputial ring proximal to the glans, resulting in a concealed penis, or (2) in the absence of preputial narrowing, resulting in a greater proportion of the penile shaft skin provided by he inner preputial skin than the external preputial skin (“megaprepuce”). Both of these become important when considering circumcision. In these cases, circumcision performed with a Plastibell or a Gomco clamp results in excessive removal of penile shaft skin. If the circumcising incision is made along the narrow portion of the prepuce, a cicatrix will form that will “trap” the penis. This condition (trapped penis) results in a tight, firm preputial ring that requires surgical release with a rotational flap of the dorsal inner preputial skin to the ventrum of the penis.
These conditions are all relatively common. A number of successful surgical approaches address these conditions. Our preference is to harvest a flap of inner preputial skin on its vascular pedicle, transfer that pedicle to the ventrum of the penis, and suture it in place. In this way, the natural narrowing of the preputial ring is opened and the appropriate amount of residual shaft skin and inner preputial skin can then be removed to provide for good cosmesis.
When any of these conditions are noted, it is important to refrain from newborn circumcision. Circumcision will not address the fundamental problem of proximal narrowing of the prepuce that all of these boys share."
Source:
Fundamentals of
Pediatric Surgery 2011
Edited by
Peter Mattei, MD, FAAP, FACS
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Chapter 84
Penile Anomalies and Circumcision
BY Douglas A. Canning
Dr. Khan has expert in dealing with this condition and has 23 years experience in dealing this condition.
