Management of “Buried” Penis in Adulthood: An Overview

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Background:The condition of “buried” penis may arise from several factors. Although the pediatric form is a rare congenital disorder, it may become an acquired condition in adulthood, most commonly from obesity, radical circumcision, or penoscrotal lymphedema. As obesity has become a national epidemic, the incidence of this phenomenon will inevitably increase. The purpose of this article is to present current strategies in the management of this physically and psychologically debilitating condition.Methods:A literature review of the surgical management of buried penis was obtained mainly in the plastic surgery and urology literature (PubMed), from 1977 to 2007.Results:Several risk factors were identified in adult patients with buried penis, including morbid obesity and diabetes mellitus. Multiple techniques for release and reconstruction are described, including primary closure, Z-plasty, and skin resurfacing, all of which may or may not include a lipectomy. Recent publications focus on resurfacing with split-thickness skin grafts and negative-pressure dressings. These techniques have been successful in terms of graft survival and long-term cosmetic result.Conclusions:Buried penis is an unusual, difficult-to-treat condition that presents a unique challenge to the plastic surgeon and the urologist. Predisposing factors such as morbid obesity and diabetes mellitus are becoming increasingly prevalent, which suggests a potential increase in the incidence of this condition. Although no specific approach may be applicable to all patients, a combination of various techniques may be applied. In complicated and severe cases, a split-thickness skin graft to the penile shaft, reduction scrotoplasty, suction-assisted lipectomy, and/or surgical lipectomy, such as panniculectomy, may be indicated. Therapy adapted to the individual patient can result in high rates of successful reconstruction with acceptable cosmetic results.

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