What are the associated findings and management of penile webbing?

Penile Webbing: Associated Findings and Management

Penile webbing requires surgical correction with techniques tailored to the severity of the condition, with complete penile degloving, excision of abnormal dartos fascia, and penoscrotal fixation sutures showing excellent outcomes with minimal complications.

Definition and Associated Findings

Penile webbing is characterized by:

• Abnormal attachment of scrotal skin to the ventral penile shaft 1
• Likely caused by abnormal scrotal dartos insertion 1
• Results in concealed penis appearance 1, 2
• Absence of normal penoscrotal angle 2
• Abnormally short ventral penile shaft 2

Common Associated Findings

• Stenotic ring of distal prepuce (phimosis or paraphimosis) 2
• Various degrees of penoscrotal transposition 2
• Perceived penile shortening 3
• May cause delayed circumcision 3

Classification

Penile webbing can be classified as:

1. Primary webbing 4:

   • Simple
   • Compound

2. Secondary webbing 4

3. Severity-based grading (commonly used clinically) 3

Diagnostic Evaluation

• Thorough genital examination to determine the degree of webbing 1
• Assessment for associated anomalies 1
• Evaluation of the penoscrotal angle 2
• Measurement of ventral penile shaft length 2

Management Approaches

Surgical Techniques

Three main surgical approaches have been described with comparable outcomes:

1. Modified Frenkl Technique 1:

   • Complete penile degloving
   • Excision of abnormal scrotal dartos attached to penile shaft
   • Creation of well-defined penoscrotal angle using fixation sutures
   • Compensation for short ventral skin using prepuce with circumcision
   • Success rate: 98.13%
   • Low complication rate (4.7% penile edema, 1.9% wound infections, 1.9% scrotal hematoma)

2. Z-Scrotoplasty 3:

   • Preferred for severe webbing
   • Creates a zigzag incision to lengthen the skin
   • Allows for greater release of the webbing

3. VY-Scrotoplasty 3:

   • Creates a V-shaped incision that is closed as a Y
   • Effective for moderate webbing

4. Heineke-Mikulicz Scrotoplasty 3:

   • Simpler technique for minor webbing
   • May have higher risk of skin contraction

Technique Selection Considerations

• Severity of webbing should guide technique selection 3
• Z-scrotoplasty is preferred for severe webbing cases 3
• All techniques show similar complication rates (overall 6.7%) 3
• Only 2.7% of cases require surgical revision 3

Outcomes and Prognosis

• High success rates (>98%) with modern techniques 1
• High parental satisfaction rates 1, 3
• Improved cosmetic appearance 2
• Enhanced self-esteem 2
• Low complication rates 1, 3

Common Complications

• Penile edema (usually self-limited) 1
• Wound infections 1
• Scrotal hematoma 1
• Skin tags ("dog-ear") 3
• Suture tract formation 3
• Skin contraction (particularly with Heineke-Mikulicz repair) 3

Important Considerations

• Early recognition is important as it's often under-recognized by pediatricians 2
• Condition causes significant parental anxiety 2
• Surgical correction should be performed by experienced pediatric urologists 5
• Timing of surgery is typically in infancy (median age 9 months in studies) 1