The dartocavernous stitch surgical technique for prevention of recurrent phimosis in obese patients presenting for circumcision

Despite the widespread use of circumcision, several complications can arise, including cosmetic ones. Obesity is a risk factor that can lead to postoperative buried penis after circumcision due to cicatricial scarring. While there are conservative techniques requiring patient commitment to penile manipulation postoperatively to diminish the risk, it remains an ineffective maneuver. Often, surgeons may remove more penile skin than necessary to prevent this complication, or even avoid offering the procedure in these patients. We propose a new technique that prevents buried penis and recurrent phimosis after circumcision in obese patients. There were 4 obese patients, aged 27–63 years old from a single surgeon that underwent circumcision with placement of dartocavernous stitch using 2-0 polydioxanone (PDS). The technique involves placing 2 sutures at 3 and 9 o’clock attaching the proximal and distal Dartos layers to the tunica albuginea. The average body mass index (BMI) was 41.45 kg/m². Two patients had phimosis preoperatively, one had difficulties with hygiene and painful intercourse, and one had a tight foreskin and pain with intercourse. One patient had a standard circumcision performed first complicated by re-phimosis requiring dorsal slit with dartos fixation. All patients had excellent postoperative outcomes both functionally and cosmetically at a minimum of 1-month follow-up. There was no recurrence of buried penis or re-phimosis, while maintaining adequate penile shaft skin. The dartocavernous stitch is a safe and effective surgical technique, with satisfactory functional and cosmetic outcomes in patients undergoing circumcision that are at high risk of developing postoperative re-phimosis. This stitch can be performed in standard circumcision or dorsal slit.