ABSTRACT
In congenital buried penis, after separating the preputial adhesions to the glans, the preputial ring is cut at 3 and 9 o’clock. Then the penile skin is pulled backward to allow the inner leaf of the preputium to cover the penile shaft (Figure 15.7). An alternative is to cut the preputial ring in an elliptical form to enlarge the ring, and pull the penis outward to let the inner leaf of the preputium cover the penile shaft.3 In uncircumcised boys, by manually retracting the prepuce, the glans is protruded from the opening. If the opening is very narrow because of a phimotic ring, which in most cases is present, the opening is enlarged either by making two incisions at 3 and 9 o’clock using scissors, or by transecting the ring to allow passage to the glans. If scissor incisions are made, using a gauze pad, the glans is cleaned from all its adhesions to the inner surface of the preputium until the entire corona is freed. If the ring is transected, the edges of the inner surface of the preputium are held and the glans is freed from the adhesions. A traction suture is applied to the glans. The inner surface of the preputium is kept for covering the distal penile shaft. Then, with the penis pulled
outward, the proximal part of the shaft is dissected away from its adhering bands until the suspensory ligament is reached. With the penis in traction, applying two absorbable fine sutures (4/0 or 5/0) at 3 and 9 o’clock between the pubic periosteum and the tunica albuginea prevents retraction of the penis. In primary cases, usually the remaining penile and outer preputial skin is enough to cover the proximal penile shaft.
