Webbed Penis

Webbed penis is a congenital or acquired anomaly in which scrotal skin extends onto the ventral penile shaft, forming a web between the scrotum and the underside of the penis. The penoscrotal angle is lost, and the penis appears short and ventrally tethered.

It is usually an isolated anomaly. It may coexist with a buried penis, hypospadias or chordee.

Pathophysiology. The median raphe skin and dartos of the scrotum extend too far toward the glans. The web is mainly skin and dartos, with a normal corporal length.

Acquired webbing follows circumcision when too much ventral shaft skin is removed, and the remaining skin heals in a web between the scrotum and the shaft.

A ventral skin fold from the scrotum to the penis, with the penis angled ventrally. The shaft looks short, but the stretched length is normal. Most are asymptomatic, with some reporting discomfort, a cosmetic concern, or difficulty with erection and intercourse in adolescence.

• Clinical examination at rest and on traction, with measurement of stretched penile length.
• Examination for hypospadias, chordee, torsion, buried penis and testicular position.
• Review of circumcision history. Imaging is not needed, except to evaluate associated anomalies.

Differential diagnosis.

• Buried penis
• Penoscrotal transposition
• Chordee
• Penile torsion
• Micropenis
• Hypospadias

• Asymptomatic infants and young boys: observation, with reassurance.
• Surgery for cosmetic or functional concern, usually from 6 to 12 months and before puberty. Common techniques: Z-plasty or multiple Z-plasties, a longitudinal incision across the web closed transversely (Heineke-Mikulicz principle), or a V-Y or W-plasty. The aim is to restore the penoscrotal angle without tension and without compromising skin on the ventral shaft.
• If circumcision is planned in a boy with webbing, assess the web first, since the preputial skin may be needed for repair and circumcision may worsen the web.
• Perioperative cefazolin 25 to 30 mg/kg intravenously (maximum 2 g) as a single dose in children, or 2 g in adults (3 g if over 120 kg).
• Analgesia in children: paracetamol 15 mg/kg orally every 6 hours (maximum 60 mg/kg daily and 4 g daily), with ibuprofen 5 to 10 mg/kg every 6 to 8 hours (maximum 30 mg/kg daily) from 3 months of age.
• Complications: wound dehiscence, infection, scarring, recurrence of the web, and asymmetry.

Monitoring. Wound review at 1 to 2 weeks, with reassessment at 3 months and at puberty.

Referral and escalation. Refer to paediatric urology, or to urology for adolescents and adults. Urgent referral is rarely needed, except for wound infection or necrosis.