Background: Penoscrotal webbing or the webbed penis is a soft tissue deformity on the underside of the penis where excessive scrotal skin exists. This creates a web or skin fold which obliterates the penoscrotal angle and makes the penis looks artificially short in length. The webbed penis exists in a wide range of presentations of which has a classification system has been deveoped. The simple webbed penis is classified based on how far the web extends up onto the shaft but the penis is otherwise normal. The compound webbed penis is when the web exists with penile curvature or chordee.
The webbed penis is often perceived as a rare deformity but it s far more common. Estimates of up to 3% to 4% of the male population has it to some degree. The vast majority of these cases are of the simple type classification to which excision of the fold and longitudinal closure is a sufficient surgical technique. In more complex cases where the penis is curved or adhesions exists between the scrotum and penile spongiosum different techniques are needed.
The goals of the simple type of webbed penis surgery is to release the penile shaft from the scrotal skin, line the released shaft with penile skin and create a more distinct penile-scrotal angle.
Case Study: This male presented with simple type webbed penis which extended up to the midshaft of the penis. He had no erection to length issues and no penile curvature. He had unimpeded shaft extension up to the pubic area.
Unde general anesthesia the marked skin fold was excised longitudinally with a conservative approach making sure to leave adequate lateral penile skin. A wider excision was done on the excessive scrotal skin. Once the skin was removed a longitudinal fascial band was released at the penile-scrotal junction. Skin flaps were brought around for a longitudinal closure on the ventral side of the penis.The anterior surface of the scrotum was also closed in a linear midline fashion along the raphe. At a now more defined penile-scrotal junction a z-plasty was performed to prevent the risk of a postoperative contracture band developing across this junction.
The procedure eliminated the webbed skin, created a more defined penile-scrotal angle and lengthened the ventral side of the penis.
When seen just three weeks later he had a well healed incision and complete elimination of the webbed penis appearance.
In the simple webbed penis a deeper tissue release is not needed as no banding is evident. But when a deeper longitudinal band/adhesions exists the scrotum thecae, which is attached to the deep fascia of the penis, needs to released from the urethral spongiosum and the ventral part of the penile spongiosum down to the root of the penis.
Case Highlights:
1) The simple webbed penis is when a scrotal skin web extends variable distances up the shaft.
2) Most simple webbed penises can be treated by conservative fold excision and primary closure.
3) To prevent scar contracture at the penile-scrotal junction of the linear closure line a z-plasty is done.
Dr. Barry Eppley
Indianapolis, Indiana