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To introduce a new classification for the congenital anomaly of webbed penis and suggest an operative technique that can be planned according to the severity of webbing.
A prospective study was conducted in two pediatric surgical units in Egypt and UAE on babies who were referred for circumcision. A preplanned written protocol was designed before commencing the study.
A total of 5,881 babies aged from 1 day to 6 months were seen in two pediatric surgical units. The webbed penis is broadly classified into primary and secondary types. The primary is further subdivided into simple and compound.
We believe that the new classification will serve as a baseline for the anatomical variants and help to streamline the operative procedure accordingly.
The webbed penis is a congenital condition in which a web or fold of skin obscures the penoscrotal angle in an otherwise normal-sized penile shaft. This results in a pseudomicroscopic appearance of the normal penis. A penis of normal size may be concealed because it is buried in the prepubic tissues, enclosed in scrotal tissue (penis palmatus), trapped secondary to phimosis, postcircumcision cicatrix, trauma or hidden because of a large hernia or hydrocele.
A new classification based on the experience of two pediatric surgical centers is proposed. Two thousand eight hundred and sixty-seven cases were referred for circumcision from January 2004 to January 2008 at the Mafarq Hospital, Abu Dhabi, UAE, and 3,014 cases from July 2006 to July 2008 at the Abu El-Reesh Children University in Cairo, Egypt, were categorized according to a preplanned protocol.
The webbed penis is found in 236 (out of 5,881) cases, which is classified broadly into primary and secondary types. The primary is further subdivided into simple and compound as per Table 1 and Figures Figures11–6.
The aim is (a) exposure of the glands and coronal sulcus, (b) with penile skin length equal to the penile shaft length dorsally and ventrally, (c) straight organ and (d) normal penoscrotal junction.
The technique differs according to the type:
The condition of webbed penis has been discussed under a variety of names, including penoscrotal webbing, the inconspicuous penis, buried penis, penoscrotal fusion, penoscrotal pterygium and penis palmatus. It is important to highlight this condition as it may have a psychological trauma due to abnormal sexual appearance. Some cases may present with pain, abnormal stream of urine or genital dysfunction.
It should also be realized that circumcision may be contraindicated in some of theses cases. The etiology of this condition is uncertain, although it has been postulated that a disturbance in development of the prepuce may leave the ventral penis with inadequate skin coverage, resulting in the borrowing of scrotal tissue.
We are aware of only one classification proposed by Maizels et al. in 1986, in which he classified the concealed penis into normal circumcised, poor skin suspension, buried penis, webbed penis, trapped penis and micropenis. But, as far as we can ascertain, no classification was ever proposed for webbed penis. We believe, as there is a known classification for concealed penis, that webbed penis should also have a classification. We would hope that this classification will help in planning the operative correction according to the type or the degree of the webbing and have more objective measures in comparing the outcome of the different surgical techniques.
Several surgical techniques have been proposed for webbed penis under a variety of different terminologies[5–8] with no clear categorization of the underlying pathology or its severity. In this report, we are suggesting a technique that can be modified according to the type and severity of the webbing. It has been proven to be simple, reproducible and with good cosmetic result.
Source of Support: Nil
Conflict of Interest: None declared.