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Theisen et al. Plast Aesthet Res 2020;7:56 I http://dx.doi.org/10.20517/2347-9264.2020.83 Page 11 of 13

Figure 10. Significant wound complications including infection and breakdown

[5]
European Organization for Research and Treatment of Cancer 15 questionnaire , the Expanded Prostate
[7]
Cancer Index Composite questionnaire , and the Changes in Sexual Functioning Questionnaire short-
form . Furthermore, specific to sexual function and QOL, patients are often counseled that skin grafts
[38]
[19]
should undergo innervation within approximately one year after surgery , yet no studies to date have
documented time to return of sensation of penile skin grafts
Room for improvement
There are many opportunities for improvement in the management of AABP. Efforts have been made to
develop classification systems and surgical algorithms, as well as methods to ensure that our treatments
are resulting in improvements in patient-specific QOL. However, there are several different classification
systems published to date [13-15,40] and thus, despite their similarities, fall short of allowing us to compare
outcomes across series. Most series in the literature have fewer than 50 patients, highlighting the need for
collaboration between institutions and centers of excellence to develop a universal classification system
[41]
and treatment algorithm . This would allow for comparison of results across studies and promote multi-
institutional research.

In addition, we need disease-specific QOL questionnaires and outcome measures to determine which
surgical techniques result in the best functional and cosmetic outcomes. Understanding how surgery
impacts long-term sexual function, penile sensory function with split- thickness and full-thickness skin
grafts, and urinary function is critical to assist with honest preoperative counseling. We should evaluate the
role of adjunctive measures such as phosphodiesterase inhibitors at improving graft take and limiting graft
[39]
contracture . Head-to-head trials comparing different techniques would be ideal. Lastly, understanding
the relationship between buried penis and penile cancer is necessary since many patients with this
condition do not seek care for many years (if at all) because of embarrassment of their condition and/or
unawareness of surgical options for repair.

CONCLUSION
AABP is a condition that is becoming more commonly seen by surgeons due to increased community
awareness and overall prevalence. The main surgical steps to AABP repair include: release of the trapped
penis and resection of diseased penile skin, escutcheonectomy/panniculectomy, scrotoplasty if needed, and