Objectives: To systematically review the literature to determine the benefits and harms of the surgical techniques used for the correction of adult-acquired buried penis (AABP).
Materials and methods: The systematic review was registered in the PROSPERO database (CRD42021267440) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The Pariser system was used to classify surgical procedures.
Results: In total, 170 studies were identified and screened, and 21 studies (570 patients) were included. In general, high-complexity reconstructive procedures (category > III) were performed, with split-thickness skin grafts for shaft reconstruction. The pooled mean operating time was 192.2 min and the mean estimated blood loss range was 57-326 mL. No intra-operative complications were recorded. The incidence of postoperative complications varied across studies (0-80.8%), with >Grade 4 complications reported in 3.1-3.7% of cases. Wound infection and genital lymphoedema were reported in 4.7-33% and 7.1-60% of cases, respectively. The incidence of graft contracture and partial/total loss was 2.4-14.3% and 1.5-21%, respectively. The incidence of recurrence was not systematically reported and ranged from 5.2% to 13%. Postoperative evaluation of functional outcomes demonstrated significant improvements in sexual function, urinary function and cosmesis. Assessment of risk of bias demonstrated a high risk of bias across all studies.
Conclusions: Surgical management of AABP has a high incidence of complications but results in satisfactory outcomes, with significant improvement in patients' quality of life. The high incidence of graft-related complications should be taken into account when counselling patients and AABP care should be centralized to high-volume centres.
Keywords: abdominoplasty; acquired buried penis; hidden penis; penile lengthening; skin graft; suprapubic lipectomy.