Webbed scrotum skin#What is common in all of these surgical techinuqes is to allow ventral skin coverage without tethering to the scrotum. Surgical treatment techniques in the management of PSW include Z-plasty techniques, rotational flaps, inverted Y and complete exteriorization of the shaft. Despite multiple techniques have been reported to correct severe PSW, whichever the surgical technique is used, it is important to preserve adequate ventral shaft skin. Most minor webbing can be handled with circumcision alone. The main aims of surgical treatment are to have exposure of the glans and coronal sulcus, to have a penile skin length equal to the penile shaft length, to have a straight organ and to get a normal penoscrotal angle. Excision of excess fat is another choice of surgical managent of PSW but this method is largely reserved for adult patients. These are incision of web transversely and closing vertically, Z-plasty at the penoscrotal junction and penoplasty double-V scrotoplasty. Several surgical techniques have been proposed in the surgical management of these children. Fortunately except for cosmetic problem, the presented case in this report did not have urinary symptoms due to PSW. Some cases may present with pain, abnormal stream of urine, local infection, urinary retention and undirected voiding. Parents of children with PSW usually seek medical advice because they think that their child’s penis is too short with regard to child’s age. Although its usefulness in clinical practice is questionable, Koutby and El Gohary proposed a grading system which characterized PSW into one of seven subgroups. It may also cause psychological trauma due to abnormal appearance. With a loss of penoscrotal angle, it may cause sexual problems during the later adult life of these children. PSW is caused by scrotal skin extending onto the ventral surface of the penile shaft. Despite these studies, buried penis is still not a well-defined entity. in 1986 offered a classification as “buried penis” (patients with redundant suprapubic fat), “webbed penis” (scrotal skin obscures the penoscrotal angle), “trapped penis” (penile shaft is entrapped in the prepubic fat due to trauma or overzealous circumcision), “micropenis” (a penis less than two standard deviations below the mean size) and “diminutive penis” (small penis due to epispadias/exstrophy, severe hypospadias, etc.). There is an interchanceable terminology on this issue and Maizels et al. The true prevalance of this condition is not known exactly and the condition usually becomes problematic when circumcision is requested. Depending on the degree of anomaly, penis is either completely or partially absent. Various surgical techniques have been proposed for PSW with different terminologies Herein we present a 7-year-old boy with PSW treated using Z-plasty and surgical treatment of PSW is discussed with regard to relevant literature.īuried penis is a condition where the penis is “concealed” under the suprapubic area. Pain, abnormal stream of urine or genital dysfunction have also been reported. It may produce psychological trauma for the child due to abnormal genital appearance. It may be described as extension of scrotal skin onto the ventral surface of the penile shaft obscuring the penoscrotal angle, probably due to abnormal dartos bands. Penoscrotal Webbing (PSW) is a penile and scrotal skin abnormality that is considered in the spectrum of buried penis. For the complete type, the phallus is completely invisible and the glans is covered by prepuce. The proximal half of the penile shaft is buried in subcutaneous tissue in the partial type. The condition was further described as “complete” or “partial” by Crawford in 1977. Since its first description by Keyes in 1919 as “absence of penis exists when the penis, lacking its proper sheath of skin, lies buried beneath the integument of the abdomen, thigh or scrotum” buried penis poses significant problems both to patients and to clinicians dealing with this problem.
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