Comparative efficacy of flap transfer combined with modified Devine or Brisson procedure for correction of concealed penis in children following misdiagnosed circumcision*

Abstract Objective To compare the efficacy of flap transfer combined with either the modified Devine procedure (MDP) or the modified Brisson procedure (MBP) in correcting concealed penis (CP) in children following misdiagnosed circumcision. Methods This study included 92 children with CP who had previously undergone misdiagnosed circumcision and were admitted to Nantong First People's Hospital between September 2020 and January 2023. Using a random number table, participants were randomly assigned to either the control group (n = 46), which received flap transfer combined with the modified Devine procedure (FT-MDP), or the study group (n = 46), which underwent flap transfer combined with the modified Brisson procedure (FT-MBP). All patients were followed up for six months postoperatively. Surgical parameters, pain levels, perioperative stress response, postoperative recovery, complications, and family satisfaction were compared between the two groups. Results There was no statistically significant difference in operation time between the groups (P > 0.05); however, the study group experienced significantly lower intraoperative blood loss (P < 0.05). FLACC scores at 4, 12, and 24 hours postoperatively showed significant differences across time points (P < 0.05), but there were no significant differences in pain scores between the groups (P > 0.05) or in the trend of FLACC score changes over time (P > 0.05). Preoperative and 24-hour postoperative levels of adrenaline (Adr) and cortisol (Cor) were comparable between groups (P > 0.05). Postoperative penile length increased significantly in both groups (P < 0.05), with the study group showing significantly greater penile and penile extension lengths (P< 0.05). The duration of postoperative prepuce edema was similar in both groups (P > 0.05), as was the overall complication rate (P > 0.05). Notably, family satisfaction was significantly higher in the study group (P < 0.05). Conclusion Both FT-MDP and FT-MBP are safe and effective surgical options for correcting CP in children following misdiagnosed circumcision. However, FT-MBP provides additional benefits in enhancing penile length and improving family satisfaction.