Penile Adhesions and Skin Bridges - An Overview

Introduction

Penis is the external organ of the reproductive system in males. It mainly consists of three parts; the root (radix), or the fixed part of the penis; the body (shaft), which is a free part of the penis; and the glans, the head, or the distal part of the penis. The two main functions of the penis include sexual intercourse and urination. The skin of the penis is connected to the underlying fascia by loose connective tissue and is more pigmented than the rest of the body. Various conditions can affect the function and appearance of the penis, of which some are congenital while others can occur later in life due to injury, infections, or diseases. A urologist may be consulted to diagnose and treat the disorders of the penis.

What Are Penile Adhesions and Skin Bridges?

Penile adhesions, also called prepuce adhesion, occurs when the skin of the penis shaft adheres to the glans. It can occur in both circumcised and uncircumcised males. On the other hand, skin bridges occur due to the attachment of the shaft of the penis to the coronal margin. Penile adhesions, when not treated, can also lead to the formation of skin bridges. These are larger, comparatively thicker, and more permanent attachments. Penile adhesions can resolve independently in infants or young boys. However, some cases may require treatment, whereas skin bridges may require surgical intervention.

What Are the Types of Penile Adhesions?

Penile adhesions can be seen in many forms; they can be attached circumferentially, medially, laterally, as a bridge from the shaft to the glans, or as a combination of all these. However, the three main types of penile adhesions include:

• Glandular Adhesion: It is a small adhesion that occurs when the shaft skin gets attached to the glans (head) of the penis. It usually resolves on its own.

• Penile Skin Bridge: It occurs when a part of the penile shaft skin gets healed to the edge of the penis head after a circumcision. It is generally a permanent adhesion, mostly like a scar, andoften requires treatment because it does not resolve by itself. Small skin bridges are avascular and narrow, whereas thick bridges are vascular and are treated by electrocautery.

• Cicatrix Adhesion: This type of adhesion is also called trapped penis or buried penis, wherein the penis contracts into the pubic pad of fat. It is called so because it is not possible to expose the penis, and it mostly occurs after a circumcision procedure.

What Are the Causes of Penile Adhesions and Skin Bridges?

Some penile adhesions develop if the foreskin is not properly removed during the circumcision in a newborn, or may also form due to fat accumulation in the pubic area as the infant grows. The exact cause of penile adhesion remains unknown, but several possible factors are proposed such as incomplete separation of the preputial skin or an injury to the glans during circumcision. It can vary in severity among individuals and can be found anywhere around the glans. During the healing process, the skin of the shaft can get adhered to the glans or the adhesions can get partially separated at the corona to form bridges. Therefore, in order to prevent skin bridge formation, suturing and dressing must be done carefully at the time of circumcision. However, penile skin bridges occur only after a circumcision (especially in a newborn circumcision).

What Are the Symptoms of Penile Adhesions and Skin Bridges?

Penile adhesions and skin bridges do not cause pain and are mostly asymptomatic in infants and young boys. It may be noticed as the child grows and when the penis appears to be buried in the pubic fat pad. Rarely, it can cause redness or irritation. Sometimes, a white discharge or debris resembling a pus is noticed which accumulates under the foreskin and gets trapped within the area of adhesion. It is called smegma which is a collection of dirt, oil secretions, and dead skin cells. In adults, penile adhesions feel like a tugging sensation during an erection and may cause pain if left untreated. Therefore, it must be treated as soon as noticed because it may not require invasive procedures when diagnosed early.

How Are Penile Adhesions and Skin Bridges Diagnosed?

Penile adhesions are usually not associated with pain or discomfort, hence it may be diagnosed by the doctor during a routine physical examination. The doctor may also use an instrument called a cystoscope to closely examine the condition. Penile adhesions may also be noticed in infants by parents or caretakers during diaper changes or bath time. Though it does not require immediate treatment, it is always better to get evaluated by the doctor to prevent further adherence or complications.

How Are Penile Adhesions and Skin Bridges Managed?

Most cases of penile adhesion resolve on their own or can be released by simple retraction, but sometimes the fusion may be so complete that it requires a referral to the urologist. Penile adhesions can be managed by the following methods:

• Petroleum Jelly: These are semi-solid products that keep the penile area moist, soften the adhesions, and break them apart. It is usually recommended for babies or infants as parents may be reluctant to apply steroid creams. Redness may be noticed in the area after the adhesion separates which is completely normal. Wet and sticky diapers can increase the risk of penile adhesions in infants, hence changing the diapers frequently and maintaining hygiene are also important. Petroleum jelly can be applied to the glans by gently pulling the foreskin in normal infants to prevent adhesions.

• Steroid Cream: Penile adhesions can be managed by the application of topical steroid cream such as Betamethasone, twice a day for around four to eight weeks. It decreases inflammation, increases elasticity, thins the skin around the adhesions, and treats gradually over time. If the steroid creams cause skin discoloration or irritation, a doctor must be consulted in such cases.

• Surgery: When conservative methods do not work, the adhesion needs to be separated by a specialist at a clinic. Usually, thick and scarred adhesions or bridges require this method, wherein a topical anesthetic agent, such as a Lidocaine cream, is applied to the affected area. After the area is numb, a small cut is made to separate the adhesion.

• Recircumcision: It may be performed in some cases if the skin of the penis is frequently irritated or infected or if the density of adhesion is causing severe discomfort to the individual.

Conclusion

Penile adhesion can occur after circumcision or due to the accumulation of fat in the pubic area in infants. Penile adhesions, when left untreated, can cause the development of skin bridges. These are usually asymptomatic in nature but can cause discomfort during erection. Penile adhesions usually resolve by itself or by conservative treatment, while skin bridges may require surgical intervention. Washing the penis regularly using soap and water and maintaining proper hygiene can help prevent penile adhesions.