Introduction: Buried penis repair (BPR) is typically performed for morbidly obese men with associated comorbidities. Case complexity is variable and often involves penile split thickness skin grafting (STSG) and use of vacuum-assisted closure (VAC). At our institution, BPR is performed with a multidisciplinary team involving urology and plastic surgery. Collectively, we sought to determine the rate of 30-day complications to determine areas for team-based quality improvement and information relevant to preoperative patient counseling and prehabilitation.
Methods: With IRB approval, all cases of BPR from 2012 to 2021 were reviewed. Data was collected for patient demographics, operative case characteristics, and 30-day complications using the Clavien-Dindo classification.
Results: Overall, 63 men underwent BPR for the studied interval. Mean age was 55.9 ± 14.4 years and mean BMI was 41.99 ± 9.17 kg/m2. The rate of overall complications was 33% (21/63). Major complications were seen in 8% of patients, classified as Grade IV (4) and Grade III (1). BMI was an independent predictor of complications (p=0.0257). Additionally, patients noted to have preoperative UTI, even when treated, had significantly higher rates of readmission (p=0.006) and unplanned emergency room (ER) visits (p=0.0006). Baseline hypertension (HTN) was independently associated with ER visits (p=0.0148), but not with overall complications. Presence of home assistance, age, history of CAD or PVD, and preoperative A1c values were not associated with overall complication rate. There was no difference in complications with hospital or home negative pressure wound VAC systems.
Conclusions: Short-term complications following BPR were noted in a third of patients, despite multidisciplinary management. Despite all patients having obesity, BMI was a significant predictor of complications. Patients with a history of preoperative urinary tract infection or HTN also appear to be at increased risk. Quality improvement initiatives targeting monitored preoperative weight loss, urinary assessments with test-of-cure and/or prophylaxis, and more aggressive blood-pressure management will be studied prospectively. Patient counseling will also involve setting expectations on the frequency of complicated recovery.
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