BJU International 2000 86 (4),  523

These three papers describe methods of treating variations on the theme of the buried penis. The paper by Shenoy et al. discusses the use of liposuction together with surgical realignment of the skin in older children (aged 9–13 years). Whilst the figures show a reasonable cosmetic result, I cannot help wondering whether the same effect could not have been achieved by calorie restriction, exercise and the use of either testosterone injections or dihydrotestosterone cream to enlarge the phallus. I am sure that the authors will react to my comments in the correspondence section.

The paper by Summerton et al. discusses the surgical correction of an interesting condition that was first reported in 1994 in the BJU. Whether this is truly congenital or not remains open to debate. The photographs of the results of surgery look reasonable. In my practice we tend to make a dorsal slit as the initial surgical procedure, as is mentioned by the authors, leaving any further penile surgery if required until the age of 3 or 4 years. We will be reporting our experience fairly soon, as some children have required no further surgery other than the initial dorsal slit, although they are a minority. However, the surgery that Summerton et al. describe is quite extensive, and if anything less can be performed it would be an obvious advantage.

The paper by Smeulders et al. describes the GOSH approach to the problem. The surgery appears simple, the illustrations are excellent and the end result, although the traction suture does seem to be pulling on the penis, appears good. That three papers have been published about variations of the same pathology merely confirms that this is not an easy condition to treat and surgery is best left to experienced paediatric urologists. As no single operation has received widespread acclaim for the treatment of these conditions the ‘perfect answer’ is still awaited. Why do our adult urological colleagues not see this condition in the older patient? Have all the patients with these conditions undergone surgical correction in childhood? I doubt it. Does it usually correct itself as the patient goes through puberty? I think this is more likely, but I shall be interested to hear what our colleagues in adult urology think.

J.D. Frank, Assistant Editor