BACKGROUND:: We present our experience with reconstructive strategies for men with various manifestations of A-BPS, and propose a comprehensive anatomic classification system and treatment algorithm based on both pathologic changes in the penile skin and involvement of neighboring abdominal and/or scrotal components. METHODS:: We reviewed all patients who underwent reconstruction of A-BPS at our referral center between 2007 and 2015. We stratified patients by location and severity of involved anatomic components. Abdominal and scrotal involvement was determined preoperatively, while viability of the penile skin was often determined intraoperatively. We reviewed procedures performed, demographics, comorbidities, and clinical outcomes. RESULTS:: Fifty-six patients underwent reconstruction of buried penis at our center from 2007-2015. All procedures began with a ventral penile release. If the uncovered penile skin was determined to be viable, a phalloplasty was performed by anchoring penoscrotal skin to the proximal shaft, and the ventral shaft skin defect was closed with scrotal flaps (VSSF). In more complex patients with circumferential non-viable penile skin, the penile skin was completely excised and replaced with an STSG. Complex patients with severe abdominal lipodystrophy required adjacent tissue transfer (ATT). For cases of genital lymphedema, the procedure involved complete excision of the lymphedematous tissue, and primary closure with or without a STSG, also often involving the scrotum. Our overall success rate was 88% (49/56), defined as resolution of symptoms without the need for additional procedures. CONCLUSIONS:: Successful correction of adult buried penis often necessitates an interdisciplinary, multi-modal approach, and excellent outcomes are possible with appropriate patient selection.
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