Discussion
penile edema, penile skin necrosis, penile skin congestion
GROUP B, PENILE EDEMA, SKIN INFECTION, PENIS, COMPLICATIONS
Several techniques had been described for the management of concealed penis without a single procedure showing complete satisfactory results. These procedures include; phallopexy alone (anchoring of penile skin dermis to Buck's fascia at penile base), dartos excision alone, and phallopexy after complete dissection and excision of dartos fascia. Excision of dartos fascia -which was done in patients of Group B as an only step and in patients of group C in combination with phallopexy in our study- was recommended for surgical correction of such conditions by several researchers like Alter et al. [Another proof of the importance of dartos excision in the case of the concealed penis was concluded by Widi Atmoko et al. [Phallopexy was done in our study without excision of dartos fascia in patients of group A and after complete dissection and excision of dartos fascia in patients of group C. This technique was studied by Emrah Aydin et al. [Another description of the importance of phallopexy was concluded by Gary et al. [Penile fixation (phallopexy) after complete dissection and excision of dartos fascia was done in this study with good follow-up results. Joseph [No available study in the literature compared dartos excision alone, phallopexy alone, and the combination of both techniques which was the aim of the current study. The age of the studied patients was slightly lower than that of the patients who were included in the Valioulis et al. [Follow-up of the studied patients in the current study revealed that most of the studied patients developed post-operative penile edema and only one patient developed skin infection; these complications did not vary significantly among the studied groups and responded well and rapidly to conservative treatment. This observation was similar to the findings of Kassem et al. [None of the studied patients developed post-operative penile skin necrosis as meticulous dissection with great attention to preserving skin vascularity was done. On the other hand; seven patients (4.7%) developed penile skin congestion with gradual and spontaneous improvement. These observations were similar to the findings of Kassem et al. in their study who observed minimal post-operative complications associated with early management of buried penis [Fifteen patients (10%) developed post-operative penile re-retraction with redundant skin over the glans penis. The best results with the lowest incidence of re-retraction were observed in patients who were treated by phallopexy after complete dissection and excision of dartos fascia. However, the highest incidence of this outcome was observed in those who were treated only by dartos excision. Those patients were managed by educating the parents to do regular backward retraction of the skin and meticulous cleaning.The incidence of post-operative penile re-retraction in our study was higher than that observed by Cheng et al. [Other surgeons believed in the importance of the dartos layer and avoided its excision in the treatment of buried penis and innovated a new technique of doing dorsal dartos flap fixed at both sides of the penile base with satisfactory results as compared to fascia fixation [