Definition
Buried penis refers to a condition where a normally sized penis is hidden beneath the surrounding skin, such as the abdomen, thigh, or scrotum. This condition is often seen in children, particularly neonates or obese prepubertal boys, but it can also occur in adults. Both circumcised and uncircumcised individuals can be affected, and milder cases may go undiagnosed until adulthood, especially as increased fat deposition can exacerbate the issue.
Classification
Various classification systems for buried penis exist but have not achieved universal acceptance. The main terms used include:
- Concealed Penis: Refers to cases before circumcision.
- Trapped Penis: A condition resulting from cicatricial scarring after overzealous circumcision.
- Buried Penis: Typically associated with obesity and occurs during adolescence.
Most congenital cases in children are self-limiting, while untreated adults may see a worsening of the condition due to the growth of abdominal fat.
Causes
The etiology of congenital buried penis includes:
- Dysgenetic Dartos Tissue: Abnormal attachments of dartos fascia can prevent the penis from being fully exposed.
- Prepubic Fat Pad: A prominent fat pad can conceal the penis.
- Cicatricial Scarring: Overzealous circumcision can lead to trapped penis.
- Genital Lymphedema: This may be idiopathic, related to prior surgery, or acquired (e.g., from filariasis).
In adults, conditions like obesity, trauma, prior surgeries, or diabetes mellitus may contribute to the development of buried penis. Significant laxity of abdominal skin after procedures like gastric bypass or abdominoplasty can also play a role.
Treatment
Numerous surgical techniques exist for repairing buried penis, with variations based on the underlying cause. Potential considerations include:
- Pediatric Repair: In pediatric cases, it is essential to divide dysgenetic dartos bands and fix the dartos fascia to the Buck fascia in various orientations. Care must be taken to avoid damaging the urethra or neurovascular bundles.
- Adult Repair: For adults, defatting the mons pubis is often necessary. This can be done through excisional lipectomy, liposuction, or both. The necessity of suspensory ligament release is debated, but it is usually unnecessary.
- Skin Deficiency: In cases of trapped penis where there is insufficient longitudinal penile skin, a rearrangement (plasty) of the skin may be performed. Severe deficiencies may require split-thickness or full-thickness skin grafts. Skin grafts can be applied in a spiral fashion once proper fixation has been achieved.
Considerations
When contemplating surgical reconstruction, it’s vital to discuss potential functional, cosmetic, and psychosocial outcomes with the family. Young patients with concealed penis may face ridicule from peers, while those with severe buried penis may lack visible penile shaft when standing, necessitating sitting to urinate.
Conclusion
Buried or trapped penis can have significant implications for the physical and emotional well-being of affected individuals. Timely diagnosis and appropriate surgical intervention can help improve outcomes and quality of life.