Abstract
We thank the editors for their insightful comments on the increasingly common and difficult-to-treat condition of adult acquired buried penis. We echo their support for lifestyle changes in conjunction with referral to a reconstructive urologist for the consideration of surgical management. In addition to the highlighted key aspects of the surgery the editors describe, we would add the need for the creation of a tension-free, well-vascularized abdominal flap that easily reaches the base of the penis and the excision of all edematous and fibrotic native penile skin. The former ensures a tension-free reconstruction to limit postoperative wound complications. In most expert opinions, the latter is necessary as these patients have either fruitlessly been offered and had undergone circumcision in the past, exacerbating their condition by creating a cicatrix of scarred penile skin, or the buried phallus has been buried so long that chronic edema, fibrosis, and lichen sclerosis have destroyed the pliability of the skin, rendering it useless in the surgical repair. 1 Cavayero C.T. Cooper M.A. Harlin S.L. Adult-acquired hidden penis in obese patients: a critical survey of the literature. J Am Osteopath Assoc. 2015; 115: 150-156 Crossref PubMed Scopus (3) Google Scholar
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