What are the associations and treatment options for penile webbing?

Penile Webbing: Associations and Treatment Options

Penile webbing is primarily associated with abnormal attachment of scrotal skin to the ventral penile shaft and can be effectively treated through surgical correction using techniques such as penile degloving with excision of abnormal dartos fascia and penoscrotal fixation sutures. 1

Definition and Types of Penile Webbing

Penile webbing (also called penoscrotal webbing) is characterized by:

• Abnormal attachment of the scrotal skin to different levels of the ventral penile shaft
• Possible etiology includes abnormal scrotal dartos insertion
• Can be congenital or acquired (commonly post-circumcision)
• May cause a concealed or buried penis appearance

Penile webbing is typically classified into grades based on severity:

• Grade 1: Mild webbing
• Grade 2: Moderate webbing
• Grade 3: Severe webbing with significant concealment of the penis

Associations and Impact

Penile webbing is associated with:

1. Psychological impact: Similar to other penile conditions, webbing can cause significant psychological distress and impact quality of life 2
2. Sexual function concerns: May affect sexual function and satisfaction
3. Cosmetic concerns: Appears as an abnormal penoscrotal junction
4. Post-circumcision complication: Can develop after circumcision when insufficient ventral skin is removed 3
5. Concealed penis: Often presents alongside concealed penis, making the penis appear shorter due to retracted position 4

Evaluation

Assessment should include:

• Physical examination to determine the degree of webbing
• Evaluation for associated anomalies
• Assessment of the amount of ventral penile skin
• Determination of whether the condition is congenital or acquired

Treatment Options

Surgical Approaches

1. Penile Degloving with Dartos Excision Technique 1

   • Complete penile degloving
   • Excision of all abnormal scrotal dartos attached to penile shaft
   • Creation of well-defined penoscrotal angle using penoscrotal fixation sutures
   • Compensation for short ventral skin using prepuce tissue
   • Success rate of 98.13% reported
   • Suitable for different grades of congenital webbed penis

2. Heineke-Mikulicz (HM) Scrotoplasty 3

   • Best suited for Grade 1 post-circumcision webbed penis
   • Shorter operative time (median 45 minutes)
   • Simple technique with good outcomes

3. Multiple Z-plasty Technique 3

   • Recommended for Grade 2 and Grade 3 post-circumcision webbed penis
   • Longer operative time (median 75 minutes)
   • More complex but effective for severe webbing

4. Paraphimotic Band Approach 4

   • Commonly used for combined concealed penis and penoscrotal webbing
   • Corrects webbing without incision at the penoscrotal junction
   • Highly successful and reproducible technique

5. Y-shaped Incision Technique 4

   • Reserved for more severe defects
   • Involves Y-shaped incision at the penoscrotal junction
   • Mobilizes skin flaps to correct the deficit

Potential Complications and Follow-up

Potential complications include:

• Penile edema (4.7%) 1
• Wound infection (1.9-4.5%) 1, 3
• Scrotal hematoma (1.9-7.4%) 1, 3
• Persistent mild webbing (rare)

Follow-up should include:

• Regular assessment of surgical outcomes
• Evaluation of parental/patient satisfaction
• Monitoring for recurrence or complications
• Assessment for psychological impact and referral for support if needed 2

Multidisciplinary Approach

For optimal outcomes, treatment should involve:

• Urologists specializing in penile surgery
• Psychological support and counseling when needed
• Discussion about the impact on sexual function and appearance 2

Conclusion

Surgical correction of penile webbing shows excellent outcomes with high success rates and good cosmetic results. The choice of surgical technique should be based on the grade of webbing and whether it is congenital or acquired. Early intervention can prevent psychological distress and improve quality of life.