Buried Penis: A Rare Cause of Lower Urinary Tract Symptoms in the Pediatric Population

Abstract

A buried penis is a probably underdiagnosed entity. It is defined as a penis of normal size that appears to be smaller than expected due to concealment within the pubic tissue. This case report explores the presentation of a 12-month-old male infant with exuberant ballooning of the prepuce during micturition, requiring manual expression of urine for the duration of two months prior to presentation. The penis was not visible above the skin level, with only the glands covered by prepuce protruding. However, the penis could be exposed when holding the base of the penis, revealing a regular-sized penis. The clinical diagnosis of a buried penis with megaprepuce was assumed, and the patient was referred to the pediatric surgery department for further management. Corrective surgery was performed nine months later with excellent cosmetic and functional results. The buried penis has a typical appearance with a partially visible or completely invisible penis, with only the glans covered by prepuce protruding, and it can be completely asymptomatic or cause micturition difficulties, sexual dysfunction, and recurrent urinary tract infections or balanitis. The diagnosis is clinical and the treatment is surgical, although the surgical approach is controversial.

Keywords: lower urinary tract symptoms; micropenis; pediatrics; penile disease; penis and scrotum.

Figure 1. Ballooning of the prepuce during micturition in a buried penis with megaprepuce.

Figure 2. A: Buried penis with megaprepuce with a typical “volcano-like” appearance. B: Normal-sized penis for age exposed by applying finger pressure on the opposite sides of the shaft base.