Penile retraction: recognition and treatment

Penile entrapment is a birth defect that can be seen at birth. However, the reality shows that many cases are detected very late, due to confusion with the manifestation of foreskin stenosis and lack of parental attention. Penile burying should be treated early to avoid effects as the child gets older.

Penile retraction, also known as "penis entrapment", is a birth defect. If left untreated, penile inclusions can cause urinary effects such as recurrent UTIs, fibrous balanitis, and obstruction. Treatment of penile depression is always combined with treatment of foreskin stenosis in children.

The sign of "burying the penis" is that the penis is small, short due to deep sinking into the pubic area, the body of the penis is dropped behind only the skin tube covering the penis.
In penile inclusions, the shaft of the penis and glans are buried in the foreskin, which is continuous with the scrotum and/or abdominal wall, and thus does not protrude from the prepubic skin. When touching, only the skin tube is seen (the skin of the penis is sunken like a screw) but the penis is not visible inside. Only when the penis is erect or pressed by hand, does the shaft of the penis come out and retract while releasing the hand. When the penis is buried, the child will find it very difficult to urinate.

3.1. Principles of Penis Penile Treatment Treatment aims to restore the normal appearance of the penis.
3.2. Preoperative treatment While waiting for surgery, it is possible to dilate the foreskin to resolve urinary difficulty and urinary retention.
3.3 Surgical treatment 3.3.1. Treatment methods Depending on the cause of the penis inclusions, there are treatments as follows:
For fat children, with a thick layer of fat in the pubic area: Follow the right diet, exercise if in older children, guide The child gradually dilates the foreskin on its own. Surgery can be performed to remove the fat layer on the pubic area and around the penis during puberty. With the cause of the fibrous strip pulling down the penis body: A guide to gradually expanding the foreskin. Surgery to release and lengthen the penis at 1-2 years old. If there is a disease that has not yet descended into the scrotum, surgery is always done at the same time. If the penis is abnormally small, treatment with drugs to enlarge the penis before surgery. If your baby is 8 months old, you should take him to a pediatrician for a definitive diagnosis, from which the doctor will advise on the appropriate treatment. 3.3.2. Principle of Surgery Surgery aims to fix the base of the penis to firm but still movable structures (proximal portion of the penile fascia: fascia of Dartos). As a result, long-term results are maintained, and the penis shape continues to develop normally.
3.3.3 Indications ● Only actual penis burial is indicated for surgery.
● Surgery is not necessary for penile inclusions in obese children whose foreskin can be dilated.
● Early surgery when there is urinary retention, chronic balanitis.

3.3.4 Surgical technique (Lipszyc technique) Skin incision
Use clamps along the foreskin at 12 o'clock position to below the glans penis. Cut along the clamp line to limit bleeding. When the foreskin is retracted, the longitudinal incision becomes the transverse, extending the incision into a circle. Attach a thread to the distal part of the glans, pulling the penis forward for easier manipulation. Penile peeling
Peeling off the penis to the pubic base with scissors or electric knife. Insert a feeding tube during the removal of the penis to avoid damage to the urethra. Control the bleeding carefully. Deep fixation
Stitch the Buck fascia layer to Dartos at the base of the penis with 02 buttons that do not dissolve or dissolve slowly at the 3 o'clock and 9 o'clock positions, suture carefully, avoiding the urethra.
Skin cover
Sew the skin and mucous membrane of the foreskin to cover the penis. Place and fix urinary catheter. Bandage around the penis. Penile entrapment in newborns is a birth defect that can be seen at birth; If examined by an experienced pediatrician, it will be detected immediately by the abnormal shape of the penis, characterized by a very short or absent penile canal. Early detection and treatment of penile inclusion disease contributes to reducing discomfort and limiting possible bad complications to the child.