Suprapubic Liposuction with a Modified Devine’s Technique for Buried Penis Release in Adults

We read with great interest the article titled “Suprapubic liposuction with a modified Devine’s technique for buried penis release in adults” by Zhang et al, in which the authors described a combination technique for buried penis release and lengthening in adults, evaluating the safety and efficacy of combining suprapubic liposuction and modified Devine’s technique. ¹

We retain that there is no sufficient knowledge and awareness of this syndrome, mostly due to the difficult approach of the patients with doctors, especially if we consider that this type of syndrome not only affects the urinary function and the personal hygiene but also mostly affects the overall quality of life. ²

We congratulate the author for this complete approach to the disease, which is increasingly common, and for their results, but we have some elements to discuss.

Since patients require suspensory ligament release, we retain that with a single cutaneous access located in the hairy suprapubic area, as shown in figure 4, lipectomy can be easily achieved. Resecting the suprapubic fat pad with an open surgical excision has the main advantage of sparing the base of the penile shaft and avoids any damage to the spermatic cord and can be exploited to remove excess skin, which is often redundant in obese patients and can be worsened by liposuction. Moreover, this allows for an efficient hemostasis that may reduce the incidence of ecchymosis and hematomas.

Obesity in male populations is often associated with an increased rate of erectile dysfunction, difficulties during sexual intercourses, and early ejaculation mostly due to decreased penis vascular perfusion. Therefore, genitalia is a key element for male self-esteem, contributing toward mental and physical balance and influencing their social life. ^3,4 The authors declared that none of the patients had difficulty in sexual intercourse, but, since sexual experience includes a large variety of elements, postoperative sexual satisfaction should be evaluated with appropriate scales, such as Changes in Sexual Functioning Questionnaire short-form, to better assess if surgery improved not only the erection but also the frequency and interest in sexual intercourses, ejaculation, orgasm, and feelings of well-being. ⁵ Since the authors’ cohort of patients is sufficiently large, we retain that a complete analysis of the global sexual approach could be an interesting and innovative evidence of the efficacy of the proposed combined technique.