What is Buried Penis?
Cause
The cause of buried penis can be congenital or acquired. Acquired buried penis is more common in obese children and obese men. Most patients have a normal penis size and length. It is caused by an excessively thick subcutaneous fat anterior to the pubic area that separates the penile skin from the penile shaft, a degloving phenomenon. As a result, the normal size penis is buried inside a thick fat pad, forming a buried penis.
Symptoms
Buried penis may affect patients in the following ways:
- Buried penis may lead to inaccurate urine stream or urine stream bifurcation, resulting in urine wetting the patient's body, clothing, or the surrounding environment.
- Patients with buried penis usually cannot retract and clean their foreskin and glans of the penis. There is often urine and dirt accumulating between the glans of the penis and prepuce, resulting in bacteria overgrowth, unpleasant odors, balanitis (infection at the head of the penis), posthitis (infection at prepuce), or even urinary tract infections. Through sexual intercourse, the bacteria inside the foreskin can be passed to the patient's sexual partners, causing vaginitis, pelvic inflammatory disease, or urinary tract infections. The bacteria of the female sexual partners can pass their bacteria to the patients with buried penis, causing unpleasant odors, balanitis, posthitis, or even urinary tract infections.
- Patients with buried penis often have easy slippage of condoms or difficulty in wearing condoms.
- Buried penis will affect ejaculation. The ejaculated semen is usually trapped between the prepuce and glans of the penis, which in turn may affect fertility.
- As the glans of the penis of patients with buried penis is nearly always covered by the foreskin, the glans of the penis is usually more sensitive or even hypersensitive compared to normal men. The glans of the penis with hypersensitivity, once exposed, may result in premature ejaculation. After circumcision, when the glans of the penis is normally exposed, the skin of the glans of the penis thickens with time. Thickened skin on the glans of the penis will become less sensitive, and circumcision may improve premature ejaculation.
- Pediatric patients with buried penis usually cannot retract and clean their foreskin and glans of the penis. There is often urine and dirt accumulating between the glans of the penis and prepuce, resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitis, or even urinary tract infections. After infection and inflammation, fibrosis, scar, and tissue contraction may set in the prepuce, glans of the penis, or the shaft of the penis, affecting urination and growth of the penis.
- Patients with buried penis have ambiguous external sexual features and a short-looking penis. Patients may experience a negative psychological impact.
Diagnosis
Treatment
Traditional Buried Penis Surgery
Traditional buried penis surgery involves:
- Circumcision
- Suprapubic fat excision
- Adhesiolysis +/- abdominoplasty
- Penile skin refashioning and fixation
Traditional buried penis surgery requires excising 1-5 pounds of suprapubic fat and skin. It is a major and extensive surgery. A drain is inserted into the operating tissue to drain postoperative tissue fluid below the skin, which will be removed in a few days. Penile skin refashioning and fixation involves returning the loosened penile skin to its proper position on the penile shaft and fixing it properly.
Traditional buried penis surgery has more bleeding and more postoperative pain. It requires cleansing of wounds with distilled water, normal saline, or antiseptic. Patients usually need to rest for at least 1-2 weeks after surgery before going back to work or school. Patients can perform mild exercise 4 weeks after surgery. Sexual intercourse can be resumed 4-6 weeks after surgery.
New Buried Penis Surgery
The New Buried Penis Surgery involves:
- Laser circumcision
- Adhesiolysis
- Repositioning of the suprapubic fat
- Penile skin refashioning and fixation
Circumcision is nearly always performed with buried penis surgery because it creates a window to access the deeper structures. Through this tiny circumcision opening, experienced surgeons can perform adhesiolysis, reposition the suprapubic fat, and refashion and fix the penile skin. The wound is closed with tiny absorbable sutures and reinforced with cyanoacrylate glue.
During the new and simplified buried penis surgery, a CO2 laser is used, which has the advantage of less intraoperative bleeding and less postoperative pain. Postoperatively, patients need no wound cleansing after each urination. The new buried penis surgery has the advantages of low to nearly zero postoperative wound pain. The cut wound is neat and tidy. All patients need to do is keep the wound dry. Patients can return to school or work in a few days. Normally, moderate exercise could be performed 3-4 weeks afterwards. As the wound heals, sexual activities could be resumed 4-6 weeks after the new buried penis surgery.
