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Buried penis

Children – abnormality of penoscrotal fusion, with penile corpora tethered to deep fascia of lower abdominal wall.

Adults – largely associated with lymphoedema, obesity or penile injury secondary to surgery, inflammation or recurrent infection.

 

Acquired buried penis – penis concealed within the subcutaneous tissue of the perineum and pubic area.

 

Aetiologies:

  • Anatomical penile shortening
    • Trauma
    • Penile cancer and subsequent surgery
    • Peyronie’s disease
    • Corporal fibrosis
  • Excess adipose or skin
    • Acquired buried penis
  • Congenital
    • Abnormal scrotal position, abnormality of penoscrotal fusion
    • Micropenis
  • Skin loss
    • Penile surgery, circumcisions
    • Chronic inflammation and BXO
    • Chronic scarring
    • Fournier’s

Adults may have difficulty passing urine, dribbling, sit to void, sexual dysfunction, psychological distress, painful erections and skin changes.

 

History

  • Weight gain/loss, endocrine conditions, diabetes, thyroid disease, LUTS, sexual function, level of bother, travel to areas endemic for Wuchereria bancrofti (filiariasis)
  • Surgical history – particularly circumcision, BXO

 

Examination

  • Lying and standing. Phimosis or balanitis. Stretched penile length.

 

Goals of treatment:

  • Relieve psychological distress
  • Reduce associated pain
  • Improve sexual function
  • Improve urinary function
  • Improve cosmetic appearance

 

Conservative management

  • Weight loss (dietary, exercise physiological, bariatric surgery)
  • Psychosexual counselling
  • VED / traction devices

 

MDT approach – dietitian, plastics, psychology, wound nurses, anaesthetists, bariatric surgeons

 

Penile and scrotal reconstruction:

  • Fat removal and unburying techniques – lipectomy, excision of suprapubic fat pad, division of suprapubic ligament, apronectomy/abdominoplasty
  • Penile implants
  • Scrotoplasty

 

Principles of successful buried penis surgery:

  • Release or excision of scarred and damaged skin
  • Removal of as much pannus as possible
  • Reestablishment of normal male pubic region
  • Reattachment of median raphe to base of penis
  • Resurfacing of denuded penile skin with split thickness grafts, trying to avoid contracture
  • Immobilisation of graft with dressings