V-I penoscrotal reconfiguration: a simple new technique in the treatment of congenital webbed penis

Introduction: Congenital webbed penis (CWP) describes a condition in which the ventral skin of the penis is fused with the median raphe of the scrotum, thereby obscuring the penoscrotal angle. Materials and methods: We retrospectively reviewed the clinical notes of 21 patients undergoing treatment of CWP with “V-I penoscrotal reconfiguration technique”. CWP was assessed according to the classification of El-Koutby which includes Grade 1: the webbed skin reaches the proximal 1/3 of the penile shaft; Grade 2: the webbed skin extends to the mid 1/3 of the penis; Grade 3: the web extends to the distal 1/3 of the shaft. If phimosis was associated, this was graded according to Meuli’s classification into 4 degrees. The degree of parental satisfaction was quantified in 5 degrees according to the Likert Scale: “very unsatisfied”: score 0; “unsatisfied”: score 1; “neither satisfied nor unsatisfied”: score 2; “satisfied”: score 3; “very satisfied”: score 4. Results: CWP was grade 3 in 11 patients (52%), grade 2 in 5 patients (24%), and grade 1 in 5 patients (24%). Furthermore, it was present as isolated malformation (5 cases, 24%), associated with phimosis (11 cases, 52%), associated with hypospadias (3 cases, 14%), associated with hypospadias and phimosis (2 cases, 10%). Post-operative follow-up included clinical assessments at 2 weeks and then at 1, 6, and 12 months. No postoperative complications were noted during the follow-up. Even the one-year follow-up did not show any blemishes or scar retractions with penile curvature. In no case was necessary a reoperation. The aesthetic result was excellent in all cases. Regarding the parental satisfaction score in 17 cases parents reported a score of 4 and the remaining 4 a score of 3, especially for the aspect of the circumcised penis. Conclusions: The webbed penis is an infrequent congenital malformation, which causes psychological distress, especially in parents. Additionally, possible functional problems may arise during sexual activity in adulthood. Its correction in pediatric age is therefore desirable, to prevent possible psychological and sexual. In our opinion, the described “V-I reconfiguration technique” is simple to perform, and easy to reproduce with excellent aesthetic and functional results.