| Objective: This study aims to analyze and compare the therapeutic effects of two newly modified surgical techniques,namely the Modified Devine Surgery and the Modified Shiraki Surgery,in the treatment of congenital concealed penis.The objective is to identify a surgical approach that can improve the appearance of the penis,while minimizing postoperative complications,shortening the recovery period,and being relatively easy to implement.Methods: The retrospective analysis of 178 cases of congenital concealed penis treated at our hospital from June 2020 to June 2022 was conducted.Of these cases,93 were treated with the modified Devine surgery(Group A)and 85 were treated with the modified Shiraki surgery,which was further divided into the six-flap method(Group B1,32 cases)and the four-flap method(Group B2,53 cases).We compared the pre-and postoperative penile length,postoperative penile elongation,surgical duration,and postoperative complications between the two groups.The log-rank test was used to assess the significance of differences in edema resolution between Group A and Group B,as well as between Group B1 and Group B2.Postoperative penile appearance was evaluated using the Boemers’ scoring system for penis appearance,and patient satisfaction was assessed using the PPPS.Results: The median age of the children in both groups A and B was 6 years.The mean surgical time for group A and B were(43.69±3.80)min and(53.56±4.96)min,respectively,with a statistically significant difference(t=14.991,P<0.001).The pre-and post-operative penis length for group A were(2.10±0.61)cm and(4.86±0.75)cm,respectively,with a statistically significant difference(t=51.789,P<0.001).For group B,the pre-and post-operative penis length were(1.66±0.45)cm and(4.49±0.91)cm,respectively,also with a statistically significant difference(t=37.134,P<0.001).The median postoperative penis length increase was 2.70(0.75)cm in group A and 2.70(0.90)cm in group B,with no statistically significant difference between the two groups(Z=0.588,P=0.557).The incidence of postoperative complications in Group A was 22.58%(21/93),while in Group B it was 41.18%(35/85),and the difference was statistically significant(P=0.008).There were statistically significant differences between the two groups in terms of phimosis edema and incision scar hypertrophy(P=0.017,P=0.047),while there were no significant differences in other complications.The differences in edema resolution between Group A,Group B,and the subgroups of Group B were all significant(P<0.001,P=0.04).The external appearance of the penis was rated as good or fair in all 178 cases without any adverse events.The rate of good external appearance in Group A was 93.55%(87/93),which was significantly higher than that in Group B,which was 83.53%(71/85)(P=0.049).The difference in the rate of good external appearance between subgroups B1 and B2 in Group B was also statistically significant(P=0.024).There was no statistically significant difference in satisfaction between Groups A and B in the satisfaction survey(P>0.05).Conclusion: Both Modified Devine Surgery and Modified Shiraki Surgery are effective in treating congenital concealed penis,with good postoperative appearance and fewer complications,and are worthy of clinical promotion and application.Modified Devine Surgery is simple in operation,short in operation time,and has fewer postoperative complications,with excellent appearance evaluation and satisfaction survey performance;Modified Shiraki Surgery can solve the problems of preputial stenosis and skin deficiency,with a broad surgical field.Among them,the "four-flap technique" is superior to the "sixflap technique" in terms of appearance evaluation and complications. |
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