Extremely Obese Patients With Buried Penis
Lichen sclerosus (LS) is an underdiagnosed disease of adults and children that has a multifactorial etiology. After excision, tissues should be sent for histological analysis because LS can be associated with malignancies. LS associated with male genitals is also known as balanitis xerotica obliterans and often occurs together with phimosis. Circumcision is then the treatment of choice (1). In our department we are seeing an increasing number of extremely obese patients with buried penis. The shaft of the penis retracts into the prepubic fat apron and the warm, moist milieu around the foreskin leads to maceration and skin changes ranging up to LS (2). Circumcision alone is insufficient, because it aggravates the buried penis and leads to recurrence of LS (2). The treatment of choice is circumcision along with excision of the affected skin, removal of the prepubic fat apron, accompanied by plastic-surgical reconstruction of the penis shaft after evasion and fixation of the base of the penis (3). This is the only way of reducing the risk of LS recurrence and malignant degeneration. The rate of obesity in the world population has tripled over the past 30 years (4) and will continue to rise in the next few decades, so an increase in the number of cases of LS in extremely overweight men can be anticipated. If this disease receives too little attention in primary care and the initial surgical treatment consists merely of circumcision, higher rates of recurrence and malignant degeneration will be the consequence. Interdisciplinary cooperation between urologists and plastic surgeons enables efficient primary treatment of LS in the extremely obese with reduction of postoperative morbidity.
Prof. Ursula Mirastschijski
Department of Plastic, Reconstructive and Esthetic Surgery, Bremen Central Hospital,
Centre for Biomolecular Interactions Bremen (CBIB), University of Bremen
Prof. Sebastian Wolfgang Melchior
Department of Urology, Bremen Central Hospital, Bremen
Prof. C. Can Cedidi
Department of Plastic, Reconstructive and Esthetic Surgery, Bremen Central Hospital, Bremen
Conflict of interest statement
The authors declare that no conflict of interest exists.
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