Outcomes of adult acquired buried penis (AABP) reconstruction: a multicentre cohort study

Adult Acquired Buried Penis(AABP) is a debilitating condition often requiring surgical correction. This multicentre retrospective study, the largest of its kind in Europe to date, evaluated outcomes of 204 patients who underwent AABP repair between June 2011 and January 2025, with a median follow-up of 18.0 months(IQR 7.0-46.0). Surgical complexity was classified according to the Pariser system; 70.6% underwent high-complexity procedures(Pariser≥III). Body Mass Index ≥30 kg/m² was the leading etiological factor(45.1%), more prevalent in the high-complexity group(p < 0.001), followed by lichen sclerosus(23.0%), more prevalent in the low-complexity group(p = 0.011) and genital lymphoedema(20.1%). Main presenting complaints included sexual dysfunction(50.5%), aesthetic concerns(40.7%) and urinary problems(36.3%). Skin grafts were used in 44.6% of cases, more often in low-complexity procedures(p < 0.001). The overall complication rate was 27.0%, significantly higher in the high-complexity group(32.6% vs. 13.3%, p = 0.005), with high-complexity surgery independently predicting complications(p = 0.013). Recurrence occurred in 12.7%, with a recurrence-free survival rate of 91.5% and 83.7% at 12 and 24 months, respectively. Hematoma(p < 0.001) was associated with an increased risk of recurrence, whereas higher surgical complexity(p = 0.018) was associated with a reduced risk of recurrence. Postoperative gains included an increase in stretched penile length by 3.0 cm, improved urinary and sexual function(p < 0.001) and high satisfaction rates(86.8%). While high-complexity surgery leads to higher immediate complication rates, the comprehensive surgical approach, when tailored to the patient, offers durable results and significant improvements in function and quality of life.