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

Discussion

The pathogenesis of penile skin bridges is still under dispute. To date, the debate converges on whether it stems from incomplete prepuce excision at the time of circumcision.[1,2] As case 3 shows, we advocate that it is caused by adhesion of a remnant of fully excised foreskin to the healthy skin of the dorsal glans penis. We report two extreme cases of broad skin bridges primarily in the adult. This exaggerated phenomenon might have easily been prevented in infancy had the skin adhesions been recognized early enough, and satisfactory retraction of the proximal skin performed regularly.[3]

Further dispute has been raised in the literature whether electrocautery offers a safe and effective method of treating surgical penile conditions.[4,5,6,7] An unpublished quoted survey of the American Academy of Pediatrics Urology Section found 94% of respondents advocate use of electrical current for procedures of the penis, whereas only 26% apply this mode in practice.[5] Fears of harm caused by electric current are raised by concern that heat might accumulate at the base of the penis as electrons flow from the generator to the patient and back, thus causing tissue necrosis.[7] The proponents claim clear safety of electrocautery provided it is not applied directly to the Gomco clamp.[8,9] In our technique this disputed technique is bypassed altogether, since the chosen utensil for nonhemorrhagic skin avulsion is the less-expensive bipolar diathermy. In addition, as opposed to our predecessors when dealing with this condition, the procedure was performed outside the operating room under local anesthesia alone.

Skin bridges can appear in a variety of sizes and shapes. The minor bridges are narrow and essentially avascular, allowing hemostasis using 20% aluminum chloride solution (Drysol) or a silver nitrate stick. The thicker, more vascular bridges demand electrocautery, as in case 1. A disposable battery-powered office cautery unit, which is sometimes more easily accessible, is equally as effective as the more expensive wall-mounted units. It should be remembered that to avoid potentially harmful vasoconstriction, adrenaline must not be added to an anesthetic solution. The anesthetic can be injected comfortably through a 25-, 26- or 30-gauge needle, if available. Reattachment of the adhesion can be prevented by strict adherence to a daily manual retraction routine or by lubrication with antiseptic ointment until healing.

We have described our experiences in treating penile skin bridges in four different cases. This complaint can be found at the extreme of age-groups and yet be treated identically by the illustrated technique. Our success was achieved using local anesthesia, and the bridge excision was performed free of bleeding by means of electrocautery. When a penile skin bridge was recognized, an immediate and simple solution was accomplished without any further complications.

These cases show the advantages of this mode of therapy as a simple, brief, painless, safe, and inexpensive option. We recommend this intervention as a convenient measure for this type of condition. Furthermore, we believe that such a complaint falls in the scope of the ambulatory setting and should confidently be dealt with as an office procedure.

In the era of managed care, with insurers dictating which procedures are to be covered, expense often becomes a major determinant in deciding whether a procedure is performed or abandoned. Reducing costs by altering technique, as in this example, is of prime importance, particularly when the changes do not jeopardize patients any further. Performing a definitive intervention on the premises of casual consultation saves time and energy while enhancing trust and comfort between the patient and his physician. Familiarity with this clinical condition, as described in this report, is sufficient to guide the family physician precisely how to manage it and provide full satisfaction.

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