ČESKÁ UROLOGIE / CZECH UROLOGY – 1 / 2021

68 KAZUISTIKY Ces Urol 2021; 25(1): 62–68 vaginal coitus was not satisfactory. During the first 4 weeks the patient was advised to perform clean intermittent catheterization (2× per week) with Ch12 catheter in order to prevent onset of meatal stenosis. The final cosmetic appearance was considered very adequate (Fig. 3M). The missing penile shaft skin can be replaced either with local vascularised scrotal flaps or skin grafting. Skin grafts can be harvested and prepared as full thickness or meshed. Current literature does not provide enough evidence with regard to graft superiority. STSG is currently a well established surgical technique, with good survival rates (6, 7). To date, there is no universal treatment algorithm defined, one of the reasons is the heterogenous patient population and rarity of the disease (8, 9). In our patient, we were sceptical about scrotal skin grafting, in order not to compromise the overall anatomy after previous scrotoplasty, Although the pedicled scrotal flaps has beenwidely established in pediatric and adult patient populationwith favourab‑ le outcomes (10, 11, 12). The relative disadvantage of the scrotal graft is the presence of hair follicles, which may require secondary multiple laser treatments. CONCLUSION Surgical strategy of buriedpenis depends on the etio‑ logy and quality of affected and surrounding tissues, aswell as overall anatomy of the external genitalia. The definitive treatment and surgical goal should repair voiding/sexual functioning and overall psychological well being of these individuals. STSG is a valid alterna‑ tive for advanced cases in patients with already com‑ promised scrotum. REFERENCES 1. Pestana IA, Greenfield JM, Walsh M, Donatucci CF, Erdmann D. Management of „buried“ penis in adulthood: an overview. Plast Reconstr Surg 2009; 124(4): 1186–1195. 2. Smith‑Harrison LI, Piotrowski J, Machen GL, Guise A. Acquired Buried Penis in Adults: A Review of Surgical Management. Sex Med Rev 2020; 8(1): 150–157. 3. Palminteri E, Fusco F, Berdondini E, Salonia A. Aesthetic neo‑glans reconstruction after penis‑sparing surgery for benign, premalignant or malignant penile lesions. Arab J Urol 2011; 9(2): 115–120. 4. Miranda‑Sousa A, Keating M, Moreira S, Baker M, Carrion R. Concomitant ventral phalloplasty during penile implant surgery: a novel procedure that optimizes patient satisfaction and their perception of phallic length after penile implant surgery. J Sex Med 2007; 4(5): 1494–1499. 5. Caso J, Keating M, Miranda‑Sousa A, Carrion R. Ventral phalloplasty. Asian J Androl 2008; 10(1): 155–157. 6. Alwaal A, McAninch JW, Harris CR, Breyer BN. Utilities of Split Thickness Skin Grafting for Male Genital Reconstruction. Urology 2015; 86(4): 835–839. 7. Lindsay A, AH Muncey W, Chung PH, et al. Surgical and Functional Outcomes Following Buried Penis Repair With Limited Panniculectomy and Split‑thickness Skin Graft. Urology 2017; 110: 234–238. 8. Donatucci CF, Ritter EF. Management of the buried penis in adults. J Urol 1998; 159(2): 420–424. 9. King IC, Tahir A, Ramanathan C, Siddiqui H. Buried penis: evaluation of outcomes in children and adults, modification of a unified treatment algorithm, and review of the literature. ISRN Urol 2013; 2013: 109349. 10. Manasherova D, Kozyrev G, Gazimiev M. Buried Penis Surgical Correction: Midline Incision Rotation Flaps. Urology 2020; 138: 174–178. 11. Westerman ME, Tausch TJ, Zhao LC, et al. Ventral Slit Scrotal Flap: A New Outpatient Surgical Option for Reconstruction of Adult Buried Penis Syndrome. Urology 2015; 85(6): 1501–1504. 12. Guo L, Zhang M, Zeng J, et al. Utilities of scrotal flap for reconstruction of penile skin defects after severe burn injury. Int Urol Nephrol 2017; 49(9): 1593–1603.