Adult acquired buried penis (AABP) is recognized as a clinical condition that can obscure the penile shaft and limit the ability to perform a complete physical examination. AABP is also a known risk factor for penile cancer, and inability to visualize the shaft may hinder identification of suspicious lesions prior to surgical repair. When the penis cannot be fully exhumed on exam, standard clinical staging and lesion detection are impaired, which may affect surgical planning, including the need for more extensive oncologic procedures.
The authors aimed to assess the utility of preoperative penile ultrasound in the evaluation of patients with AABP whose anatomy prevented full physical examination of the penile shaft. The goal was to determine whether ultrasound could identify lesions that would alter clinical staging or operative management.
This work was a retrospective cohort review of ten patients with AABP who underwent preoperative penile ultrasonography prior to repair. All patients included had phalli that could not be completely exposed for examination. Surgical repair for AABP was performed by a single reconstructive urologist.
Penile ultrasonography was performed preoperatively in the cohort. Radiographic images were interpreted by a single radiologist with experience in genitourinary imaging. Color Doppler assessment was included in the ultrasonographic evaluation. The abstract does not provide further technical details such as ultrasound equipment, transducer frequency, or standardized scanning protocol.
Surgical specimens were reviewed by a genitourinary pathologist. The analysis correlated ultrasonographic findings with histopathology to determine whether ultrasound could reliably identify malignant lesions in patients with limited clinical exposure of the penis.
Of the ten patients who underwent preoperative penile ultrasound, two had physical examination findings that were concerning for possible penile masses. In these two patients, ultrasonography demonstrated tissue heterogeneity and color Doppler hyperemia of the penis. Surgical pathology for both of these patients confirmed invasive penile cancer.
The remaining eight patients did not have concerning findings on physical examination. Their preoperative ultrasound examinations were described as unremarkable. Subsequent surgical pathology in these eight patients demonstrated benign findings.
In this series, preoperative penile ultrasound identified sonographic abnormalities (heterogeneity and hyperemia) in the two patients whose pathology proved malignant, while patients without concerning ultrasound findings had benign pathology. Based on these observations, the authors propose that preoperative penile ultrasound may serve as a valuable adjunctive tool to evaluate for penile lesions in patients with AABP when physical examination and clinical staging are limited by anatomy. Use of ultrasound in this context has potential to inform surgical planning and the need for oncologic interventions.
The study did not receive grant funding from public, commercial, or not-for-profit sectors. One author (P.R.) serves as a consultant for Boston Scientific; the remaining authors declared no conflicts of interest. No additional funding or sponsorship details are reported in the abstract.
This report is a retrospective review of a small cohort (n=10) from a single reconstructive urologist with imaging interpreted by a single radiologist. The abstract does not report patient demographic details, imaging technical parameters, sensitivity/specificity metrics, or longer-term follow-up. These factors limit generalizability and preclude calculation of diagnostic performance measures from the information provided. Further, because this summary is based on the abstract, additional methodological details and broader outcome data were not reported here.
For patients with adult acquired buried penis whose anatomy prevents complete physical examination of the penile shaft, preoperative penile ultrasound identified sonographic abnormalities that correlated with invasive penile cancer in this small retrospective cohort. The authors conclude that penile ultrasound may be a useful adjunct to clinical evaluation and staging in AABP when standard examination is not feasible. Additional larger studies with standardized imaging protocols and explicit diagnostic performance metrics would be needed to define the role of ultrasound more precisely.