Treatment of Penile Webbing
Surgical correction is the definitive treatment for penile webbing, with the specific technique determined by the severity of the webbing and amount of ventral penile skin available.
Understanding Penile Webbing
Penile webbing is characterized by abnormal attachment of scrotal skin to the ventral penile shaft, creating a web-like appearance that can affect both cosmetic appearance and function. It may be:
- Congenital (present from birth)
- Acquired (commonly post-circumcision)
Assessment and Classification
Before treatment, evaluation should include:
- Determination of webbing grade/severity
- Assessment of ventral penile skin adequacy
- Evaluation of the penoscrotal junction
- Examination for associated anomalies
Treatment Algorithm Based on Severity
Grade 1 (Mild Webbing)
- Heineke-Mikulicz (HM) scrotoplasty is recommended for mild cases with adequate ventral penile skin 1
- Involves transverse incision and longitudinal closure
- Median operative time: 45 minutes
- Lower complication rate (4.5% wound infection)
Grade 2-3 (Moderate to Severe Webbing)
- Multiple Z-plasty technique is recommended for more severe cases 1
- Creates multiple Z-shaped incisions to lengthen the ventral skin
- Median operative time: 75 minutes
- Complications may include penile edema (11.1%) and scrotal hematoma (7.4%)
Complex Cases
For severe webbing with concealed penis:
- Paraphimotic band approach for moderate cases 2
- Y-shaped incision with scrotoplasty for severe cases 2
Novel Surgical Techniques
A comprehensive surgical approach should include:
- Complete penile degloving
- Excision of abnormal scrotal dartos fascia attached to penile shaft
- Creation of well-defined penoscrotal angle using fixation sutures
- Compensation for short ventral skin using prepuce tissue when available 3
This modified technique has shown excellent results with a 98.13% success rate and high parental satisfaction in pediatric cases 3.
Adult Correction
For adult patients with webbed penis causing discomfort or psychological concerns:
- Surgical correction should expose the glans and coronal sulcus
- Match penile skin length to shaft length both dorsally and ventrally
- Create a normal penoscrotal junction 4
Expected Outcomes and Follow-up
With appropriate surgical correction:
- Excellent cosmetic results can be achieved
- Penile curvature typically resolves completely
- Follow-up should occur at 1,3, and 6 months post-surgery
Common Pitfalls to Avoid
- Inadequate assessment of webbing severity before selecting technique
- Failure to address abnormal dartos fascia attachment
- Insufficient creation of penoscrotal angle
- Inadequate management of ventral skin deficiency
The success of penile webbing repair depends on selecting the appropriate surgical technique based on the severity of the condition and ensuring proper execution of the procedure to achieve both functional and cosmetic improvement.