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Thread: Webbed scrotum and hidden penis repair

  1. #1

    Default Webbed scrotum and hidden penis repair

    AAPC: Back to School
    Title of Operation:
    Repair of webbed scrotum, repair of hidden penis, plastic repair of webbed scrotum and hidden penis.

    Surgeons Narrative:

    After informed consent was obtained via a sign language interpreter and all father's questions were answered, the patient was brought to the operating room, placed supine on the operating room table. General anesthesia and a single dose caudal were administered by the Anesthesia team. Intravenous Ancef was administered. He was re-examined and noted again to have bilaterally descended testes and normal to palpation scrotum, and phimosis with a non retractable foreskin and a high insertion of webbed scrotum resulting in a hidden foreskin and a pyramidal appearance to the penis. The external genitalia were prepped and draped in sterile fashion using a small hemostat with KY jelly. This was inserted dorsally under the tight area of the prepuce and was stretched. We were then able to reduce the phimosis and re-prepped again on the glans with Betadine. The meatus was in a normal-appearing position. An 8-French urethral sound with KY jelly was used and the urethra and meatus appeared normal. A circumferential incision was made with a 15-blade on the inner preputial aspect approximately 5-7 mm proximal to the coronal sulcus into the skin and subcutaneous tissues to Buck fascia. The penis was then de-gloved down to the level of the pubis on the dorsal aspect and down to the penoscrotal junction ventrally using Black handle scissors and electrocautery. The node was made of multiple abnormal fibrous bands attached to the phallus. These were taken down and the stretched penile length that appeared to be approximately 4 cm in length and straight. The neurovascular bundles were noted and more intact. Under Buck fascia, Dr. Gearhart then scrubbed into the case. We made an incision dorsally creating too down to the level of the pubis in the dorsal prepuce and shaft skin creating 2 Byers flaps. A frenuloplasty was also done and the frenulum was then reapproximated with interrupted 6-0 Vicryl. A careful suture bleeding was undertaken using smooth forceps and pinpoint electrocautery and the field appeared dry. The shaft skin was tacked to the Buck fascia in the midline in the dorsal aspect at the base of the phallus in 2 locations each lateral to the urethra, which was identified with a 8-French urethral sound on the ventral aspect, which set the shaft skin. We then brought the ventral skin up to the frenulum and start this with a 4-0 Vicryl. A small, approximately 1-cm area of the phimosis was then closed in a vertical fashion on the ventral aspect of the penis with interrupted 6-0 Vicryl. We then took our attention to covering the dorsal aspect of the penis with a Byers flaps. They were rotated ventrally and to dorsally and closed, and this provided good skin coverage to the phallic length. The skin edges were closed with a 4-0 and 5-0 Vicryl, and then Byers flaps were brought together in the midline with 5-0 Vicryl and attached to the midline at the penile pubic junction. The incisions were then taken around at the base of the penis and the Byers flaps were fashioned to cover the skin deficit with removal of excess dog ear skin. At this point, benzoin, Telfa, and Tegaderm dressing was placed and the 4-0 Prolene marking suture, which had been placed in the glans transversed right at the beginning of the case was removed. Both testes were palpated and the scrotum at the end of the case. The cosmetic appearance of the penis was much improved. The patient was awoken from anesthesia and taken to the recovery room in good condition. Dr. Dodson discussed via the sign language interpreter, the postop management of the case, creating and leaving the dressing in place until return to clinic. Oxycodone elixir for pain management and Keflex for 5 days.


  2. #2

    Default No replies?

    No experienced Urology coders out there??

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