Classification and Treatment of the Adult Buried Penis

Abstract

In contrast to the concealed penis found in children, the adult buried penis (BP) is associated with obesity or found in patients after massive weight loss. Bariatric patients present with enormous prepubic fat masses into which the penile shaft retracts. As a consequence, urinating problems occur with wetting of the adjacent tissue. Many BP patients are circumcised with recurrence and worsening of the symptoms. In postbariatric patients, the penis is not engulfed into the prepubic tissue. In contrast to highly obese patients, the BP is covered underneath the cutaneous apron. Although all conditions are called BP, it is conceivable that plastic-surgical treatment differs. Hence, a novel classification for the adult BP was needed to adjust the procedures accordingly. We propose 3 types of the adult BP. The first type is termed "pseudo-BP." The penis is covered underneath the lax skin without signs of retraction. Here, an apronectomy and prepubic lift with tissue fixation are sufficient. The second type is the "intermediate-type BP" with partial penile invagination. After prepubic apronectomy, anchoring sutures secure the penile shaft from retraction. The third type is the "classical BP" seen in obese patients. The penile shaft is completely retracted into the prepubic fat. Often a stenotic scar tissue is found after previous circumcisions. The plastic-surgical reconstruction comprises scar excision, reduction of the prepubic fat masses with extraction of the penile shaft, anchoring sutures, and reconstruction of the penile envelope. In short, the etiology of the adult BP, a novel classification, and a treatment algorithm according to each type are presented in this comprehensive overview.