Buried Penis: Evaluation of Outcomes in Children and Adults, Modification of a Unified Treatment Algorithm, and Review of the Literature

Introduction. Buried penis is a difficult condition to manage in children and adults and conveys significant physical and psychological morbidity. Surgery is often declined due to morbid obesity, forcing patients to live in disharmony for years until the desired weight reduction is achieved. No single operative technique fits all. We present our experience and surgical approach resulting in an improved algorithm unifying the treatment of adults and children. Methods. We conducted a retrospective analysis of patients treated for buried penis between 2011 and 2012. All patients underwent penile degloving and basal anchoring. Penile shaft coverage was achieved with skin grafts. Suprapubic lipectomies were performed on adult patients. Results. Nine patients were identified: four children and five obese adults. Average postoperative stay was three days for children and five for adults. Three adults were readmitted with superficial wound problems. One child had minor skin breakdown. All patients were pleased with their outcomes. Conclusion. Buried penis is a complex condition, and treatment should be offered by services able to deal with all aspects of reconstruction. Obesity in itself should not delay surgical intervention. Local and regional awareness is essential to manage expectations in these challenging patients aspiring to both aesthetic and functional outcomes. 1. Introduction The buried penis is widely regarded as a condition which is difficult to manage both in children and in adults. Buried penis was first described by Keyes in 1919 as follows: “absence of the penis exists when the penis, lacking its proper sheath of skin, lies buried beneath the integument of the abdomen, thigh or scrotum” [1]. Buried penis has most frequently been discussed in relation to the paediatric population [2–8], with congenital and iatrogenic aetiologies identified. Buried penis in adults may have a congenital component in some cases but is largely regarded as being an acquired condition as a consequence of obesity, lymphoedema, penile trauma (including circumcision), and persistent infection, usually in the presence of diabetes. In children, presentation is often driven by parental concerns over urinary symptoms and penile size. Adult patients present with symptoms which have a profound impact on their lives. Patients can complain of being unable to pass urine while standing—and sometimes sitting—without soiling themselves, of having recurrent penile and urinary infections which are uncomfortable and antisocial, or being unable to achieve erections without pain, or to