A standardized multidimensional framework for long-term assessment of pediatric concealed penis repair: a prospective cohort study

Abstract

Abstract Background Concealed Penis is a common pediatric condition in which a normally-sized penis is partially or completely hidden beneath the prepubic skin. This study aimed to assess long-term surgical outcomes using a framework consisting of objective and subjective tools. Results The mean postoperative Concealed Index (CI) after one year increased significantly from 0.35 ± 0.09 to 0.73 ± 0.15 ( P < 0.001). No significant difference was observed between the mean immediate postoperative Index and the one-year follow-up Index (0.79 ± 0.09 vs. 0.73 ± 0.15, P > 0.05), indicating durable long-term outcomes. Regarding the modified Pediatric Penile Perception Score (mPPPS), 78.2% of parents reported being ‘very satisfied’ with long-term surgical outcomes, with a mean total score of 7.71 ± 2.66 out of 9 ( P < 0.001). At one-year follow-up, Concealed Index demonstrated significant discriminatory power in identifying penile retraction, with an area under the curve of 0.979. At an optimal cutoff value ≤ 0.7, it yielded a sensitivity of 83.33%, specificity of 92.06%, and an overall diagnostic accuracy of 90.67%. The mPPPS showed an area under the curve of 0.833; an optimal cutoff of ≤ 7 as a total score exhibited a sensitivity of 75.00%, specificity of 88.89%, and an accuracy of 86.70%. Multivariable logistic regression confirmed that both CI and mPPPS were significant, independent, and complementary discriminative tools for identifying postoperative penile retraction. Conclusions Surgical repair of pediatric concealed penis was associated with excellent and stable improvements in the objective morphometric measurements and subjective parent-reported outcomes and satisfaction scores. The combined use of the Concealed Index and modified Pediatric Penile Perception Score can successfully provide a standardized, accurate framework for long-term assessment and penile retraction identification. Clinical trial registration The study was registered on clinicaltrials.org (ID NCT07615439), insert date May 29, 2026 (Retrospectively registered).