Modified Devine-style surgery for the treatment of post-pubertal cryptorchid penis

OBJECTIVE: To report the effect of modified Devine method in the treatment of post-pubertal cryptorchid penis. METHODS: A total of 10 cases of cryptorchid penis, aged 14-26 years old, were admitted in 2012. The main diagnostic bases were: short penis appearance, bird’s beak-like, and narrow outer opening of the foreskin. Pressing the skin at the root of the penis could show the normal length penile body, or pulling the head of the penis and releasing it, the penis retracted quickly. In our group, we used the modified Devine procedure with epidural anesthesia and lying position. The foreskin was incised longitudinally, and the foreskin was turned up until the head of the penis was completely exposed, and the incision was extended ventrally in a circular shape. The outer layer of the meatus is separated so that the skin is completely desheathed to the root of the penis without cutting the suspensory ligament of the penis. The thickened meatus is transected close to the root of the penis so that the penis is completely loosened and straightened. The proximal penile skin is fixed to the white membrane at the root of the penis with a sliding thread or ordinary suture to attach the penile body; the elastic fascia under the inner plate of the foreskin is fixed to the proximal white membrane of the penis, and the penile skin is sutured together. If the dorsal skin is insufficient, the ventral skin is transferred to the dorsal side and sutured. If the incision is narrow, a longitudinal incision of 0.5-1.0 cm is made at points 2, 6 and 10 of the outer circumcision plate and points 12, 4 and 8 of the inner circumcision plate, making the incision of the inner and outer plates in the shape of a plum blossom petal. 5-0 absorbable thread was used to close the cut inner and outer skin flaps into plum blossom petals with serrated sutures to prevent contracture and stenosis of the incision. Routine catheterization, application of elastic mesh gauze wrapped penis. Postoperative antibiotics were routinely applied for 5-7 d. After 5 d, the urinary catheter was removed, the penile wrapping dressing was removed, and the elastic gauze was retained for 2-3 weeks. Results:All 10 cases were successfully operated, 2 cases had postoperative infection, which was cured after anti-inflammatory treatment.3 cases had mild edema of the distal penile skin. The penis was completely revealed and the foreskin was attached to the penis. CONCLUSION: Concealed Penis (CP) is a congenital malformation of penile development, which is not uncommon in clinical practice. Surgery is the only effective treatment for Concealed Penis, and its basic principles are: ① enlarging the narrow circumcision and lengthening the too-short penile skin; ② removing the fibrous cords and thickened meatus that restrict penile elongation, and pulling out the spongy body of the concealed penis; ③ subcutaneously fixing the root of the penis on the leucoplasty to prevent the penis from retracting. Lymphoedema of the distal penile skin is more common after this procedure, and in order to reduce postoperative edema, elastic gauze is kept for at least 3 weeks.