Novel Use of Penile Ultrasound in the Evaluation of Patients With Adult Acquired Buried Penis

Adult acquired buried penis (AABP) disease is a risk factor for penile cancer. For a subset of patients, the severity of their disease precludes complete physical examination of the penile shaft due to the inability to exhume the penis. Thus, providers are unable to identify penile lesions, which may alter surgical plans to include a more extensive oncologic treatment including penectomy. We aimed to assess the use of preoperative penile ultrasound in patients with adult acquired buried penis before surgical intervention. We performed a retrospective cohort review of ten patients whose phalli were unable to be fully exposed for examination and underwent penile ultrasonography before AABP repair with a single reconstructive urologist. Radiographic images were performed and reviewed by a single radiologist with experience interpreting genitourinary imaging. Surgical pathology was reviewed by a genitourinary pathologist. Of the ten patients who underwent preoperative ultrasound, two had physical exam findings concerning for possible penile masses. Ultrasonographic evaluation of these patients revealed tissue heterogeneity and color doppler hyperemia of the penis. Surgical specimen pathology review of both patients demonstrated invasive penile cancer. The remaining eight patients without concerning examination findings had unremarkable ultrasound findings and subsequent benign surgical pathology. Preoperative penile ultrasound may be a valuable adjunct in the evaluation of penile lesions in patients with AABP whose anatomy does not allow for complete physical examination and clinical staging.