Buried penis refers to a penis that is buried below the surface of the pubic skin as well as a partially or totally obscured penis. It is also referred to as a hidden or concealed penis.
The causes of buried penis are obesity, weight loss, congenital deformities, or an overly aggressive circumcision. The common abnormality is a lack of adequate attachments of the penile skin to the underlying erectile bodies. Therefore, the penile shaft is stationary but the skin moves forward, burying the penis. Inadequate penile skin also does not allow the penis to be completely visible. If the penis is hidden when sitting or bending over, that is a determining factor to classify a penis as buried.
A chronic buried penis can lead to inflammation and destruction of the remaining penile skin due to long-term dampness. A constricting ring (phimosis) can form on the penile shaft preventing exposure of the head of the penis at all.
A true buried penis in a child is a rare congenital anomaly that has two distinct characteristics: an abnormally large suprapubic fat pad and dense tissue that tethers and retracts the penis inward.
Most patients with a buried penis have a large pubic fat pad, but some patients with inadequate penile skin or poor skin attachments can be thin. A large pubic fat pad often combined with a lipoma of each spermatic cord and poor skin attachments, hides the penis from view. A patient after substantial weight loss can have an excess of overhanging pubic skin along with excess scrotal skin. The penile skin drapes over the penile shaft, giving the appearance of redundant skin overlying the head of the penis with concealed erectile bodies. The severity of the hidden penis can vary from partially to fully buried to only buried when sitting.
When a newborn circumcision is performed on an undiagnosed buried penis or an overweight baby, risk of removing normal shaft skin along with foreskin is very high and often worsens the situation. A typical male infant may have inadvertent removal of excess shaft skin during circumcision, which can also leave a variable amount of foreskin. Since foreskin does not have the normal attachments to the erectile chambers, the skin and penis do not remain as one unit. A circumcision may be too radical on a child or adult, preventing the penis from full extension, which causes a buried penis.
Too often, an adult primary or secondary circumcision is incorrectly performed on patients with various causes of concealment, which makes the situation worse and complicates future repairs that require the remaining penile or preputial skin to cover the penis. If there is inadequate skin, scrotal flaps or skin grafts are necessary to cover the penis while correcting the buried penis.
Parents of infants with a buried penis are often told that they will outgrow the abnormality as they age, especially during adolescence. Many of these boys will improve with growth, but some will never achieve the visual or functional length possible. These boys may have no visible penis while standing and may have to sit to urinate. A child with a severe buried penis will almost certainly not outgrow it in adolescence. Even if it improves, the ridicule from other boys and the inability to stand while peeing during childhood can cause chronic irritation and a psychological inferiority complex that can following them into adulthood.
The treatment goal of the surgery is to firmly attach adequate penile skin to the erection chambers. The surgical correction of a buried penis depends on the abnormality. However, marked improvement can be achieved in most patients by removing excessive pubic fat and suturing down the overlying skin of the pubis to the muscles. In addition, the skin at the junction of the penis and scrotum needs to be stabilized to the erectile bodies. Thin patients may require direct attachment of the skin at the junction of the penis and pubis to the penis along with scrotal skin attachment. Rarely, if there is inadequate penile skin, a skin graft or rearrangement of scrotal skin onto the penis is necessary to adequately cover it.