Office Management of Penile Skin Bridges With Electrocautery

Sody A. Naimer, MD, Roni Peleg, MD, Yevgeni Meidvidovski, MD, Alex Zvulunov, MD, Arnon Dov Cohen, MD, Daniel Vardy, MD

Disclosures

J Am Board Fam Med. 2002;15(6) 

In This Article

Methods

Four case reports of the technique of treating penile skin bridges are described, and the literature on the cause and treatment of skin bridges is reviewed.

A 20-year-old male patient came to our clinic complaining of a chronic condition that disturbed him recently. He claimed that the shape of his genital organ "just didn't seem right." He had emigrated from Ethiopia a number of years earlier and was told that he underwent traditional circumcision as a baby. He recalled this condition for as long as he can remember.

There were no specific symptoms, except for a foul odor that disturbed him little. He denied involvement in any sexual activity in the past or present. The young man chose not to consult any medical professional about this peculiarity until this point.

On examination, the anatomy of the penis appeared normal aside from the absence of the corona, which seemed completely obscured dorsally (Figure 1). There were no signs of inflammation. Close examination showed two separate adhesions, or skin bridges, orientated dorsolaterally and horizontally toward either side of the shaft. The skin bridge was inseparably confluent with the normal glans on the distal aspect and to the shaft skin proximally. An attempt to probe the virtual canals with wooden probes lubricated by white petrolatum proved successful (Figure 2). This procedure recovered underlying smegma. The area was painted with a povidone solution, and then anesthetized with 3 mL of 1% lidocaine solution without epinephrine in a 5-mL syringe by a subcutaneous injection with a 23-gauge needle at the base of the bridge. With the surface of the shaft skin safeguarded by the intact probes secure in position, electrocautery was performed over the dorsal bridges along the probes.

Double skin bridges causing complete dorsal concealment of dorsal corona.

Wooden "probes" secure in position, the bridges appear edematous immediately following local anesthesia.

The whole procedure was completed within 5 minutes without any immediate or late bleeding. Complete bridge release was successfully achieved with little discomfort to the patient (Figure 3). Gradual improvement continued until full healing was apparent at follow-up visits.

Spontaneous bridge regression apparent a number of days after hyfrecation incision.

A 62-year-old married gentleman came to our clinic complaining of a common skin condition. Before leaving, he called the physician's attention to a seemingly trivial, long-term finding. He claimed to suffer from this problem since early childhood. His main symptoms were pain during erection, which was greatly enhanced during sexual activity. He recalled being told he was circumcised normally shortly after birth in Morocco, his birthplace. When he was examined, a single dorsal skin bridge was apparent. After he consented to a therapeutic procedure, the bridge was treated as described in case 1 and released that same session, free of any bleeding whatsoever. At the follow-up visit, he told of relief of symptoms he suffered from for the past 60-odd years.

An overweight 8-day-old newborn (above 95th percentile) underwent traditional circumcision by the first author (SAN). At the time, the genital organ was observed buried inside the skin of the mons pubis. The prepuce was successfully removed by traditional circumcision and healed normally. Two months after the procedure the baby was examined again at the mother's request since she claimed "the penis seems to disappear." The body of the penis was fully sunken into the surrounding soft tissue. After extraction by local pressure, the skin of the proximal shaft was found circumferentially adherent to the corona. Forceful retraction of the shaft skin resulted in pain and minor bleeding and a gauze bandage was applied to maintain separation of the skin from the surface of the corona. The mother was instructed to perform daily manual retraction of the skin in a soap bath.

One month later at a follow-up visit, the situation was similar to the previous examination except for a genuine skin bridge, which had completely materialized on the dorsal aspect. The release procedure was performed when the infant was 5 months old, using the same technique as outlined above. Complete cure was appreciated with no recurrences as the baby grew older and became more active.

A 51-year-old devout Jewish gentleman arrived at the dermatology clinic complaining of a dermatologic condition in the inguinal area. Examination showed a solitary skin bridge. On questioning, he admitted to years of suffering from tightening and tugging of the anterior aspect of his genital organ when erect. He was immediately offered treatment as described and was both surprised and relieved when the procedure was completed in such a brief and simple fashion.

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