Buried penis

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Buried penis on a circumcised 30-year-old male not due to obesity Buried penis on 30 year old male.jpg
Buried penis on a circumcised 30-year-old male not due to obesity
Buried penis due to obesity.jpg

Buried penis, also called hidden penis or retractile penis, is a congenital or acquired condition in which the penis is partially or completely hidden below the surface of the skin. A buried penis can lead to urinary difficulties, poor hygiene, infection, and inhibition of normal sexual function. [1]

Contents

Buried penis is different from micropenis, which is an abnormally small, normally structured penis with a stretched penile length of less than 2.5 standard deviations below the mean for age or stage of sexual development of the patient. [2]

History

Buried penis was first described by Edward Lawrence Keyes in 1919 as the apparent absence of the penis due to the penis being buried beneath the skin of the abdomen, thigh, or scrotum. [3] Further research was done by Maurice Campbell in 1951, when he reported on the penis being buried beneath subcutaneous fat of the scrotum, perineum, hypogastrium, and thigh. [4]

Causes

Erect buried penis Micropenis1.png
Erect buried penis

Congenital

A buried penis may be apparent at birth in some cases, often due to a paucity of penile shaft skin and a short penile shaft. [5]

Acquired

Obesity

While not every obese male has the buried penis condition, 87% of men that received surgical treatment for buried penis were reported to be obese. Significant overlying abdominal fat can also create an environment that encourages bacterial and fungal growth. Obesity can also increase the likelihood of the development of type II diabetes mellitus, which is characterized by increase susceptibility to infections, making it difficult to successfully and promptly manage the buried penis condition. Such recurring infections can also lead to scar contracture, which can cause the prepubic skin to shift over the shaft and glans, thus invaginating the shaft's skin and leading to a buried penis. [6] [7]

Penoscrotal lymphodema

While an uncommon cause, penoscrotal lymphodema causes a deformity of the shaft and scrotum, resulting in a buried penis. [6]

Overly aggressive circumcision

In some cases of circumcision, too much foreskin is removed or the suture line constricts, causing cicatricial scarring, which can trap the penis in the remaining foreskin or push the penis into the suprapubic area and lead to a buried penis. [6]

Balanitis xerotica obliterans (BXO)

BXO is a chronic inflammatory dermatological process that causes sclerosis of the glans, shaft, prepuce, or urethra. This can result in a cicatrix of the distal penis and its entrapment. [6]

Dysgenic dartos

Dysgenic dartos is a condition characterized by a lack of dorsal support together with the hypermobility of the ventral skin and the lack of proper attachment between the dartos and the penis. This can enable the penis to "telescope" into the scrotum, thus creating a buried penis. [6]

Treatment

The condition may resolve itself without any intervention in very young children; however, patients may eventually need definitive reconstructive surgery. Urgent surgery may be necessary if infection is present. [8] [9] [10] [11] [12] [13] Congenitial buried penis can be corrected surgically in childhood by anchoring the corpora cavernosa to dartos bundles at the penile base. [14]

Surgical options could include the detachment of the ligaments connecting the base of the penis to the pubic bone; the performance of skin grafts to cover areas of the penis requiring additional skin; liposuction using catheters to suck out fat cells under the skin from the area around the penis; an abdominoplasty in which excess fat and skin from the region are removed; an escutheonectomy in which the pad of fat just above the pubic area is removed; or a panniculectomy in which the panniculus, excess tissue, and skin that hangs over the genitals and thighs are removed. [15] In a video demonstrating the use of a panniculectomy in the repair of adult buried penis, Dr. Bryan Voelzke and his colleagues emphasized the need to tack the suprapubic fat pad to the periosteum of the symphysis pubis as well as the importance of not pulling down the peno-scrotal junction and peno-abdominal junction just in order to further expose the penis. [16]

King IC, Tahir A, Ramanathan C, and Siddiqui H developed a modified treatment algorithm employing a single surgical technique consisting primarily of scar release and the mobilization of the skin of the penis. [6]

An article published in August 2019 by Dr. James J. Elist reported that a procedure involving the insertion of a subcutaneous soft silicone penile implant was successful in reversing the condition of adult acquired buried penis. [17]

See also

Related Research Articles

<span class="mw-page-title-main">Foreskin restoration</span> Process to expand skin on the penis

Foreskin restoration is the process of expanding the skin on the penis to reconstruct an organ similar to the foreskin, which has been removed by circumcision or injury. Foreskin restoration is primarily accomplished by stretching the residual skin of the penis, but surgical methods also exist. Restoration creates a facsimile of the foreskin, but specialized tissues removed during circumcision cannot be reclaimed. Actual regeneration of the foreskin is experimental at this time. Some forms of restoration involve only partial regeneration in instances of a high-cut wherein the circumcisee feels that the circumciser removed too much skin and that there is not enough skin for erections to be comfortable.

<span class="mw-page-title-main">Penis enlargement</span> Technique aimed to increase the size of a human penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

<span class="mw-page-title-main">Hypospadias</span> Medical condition

Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location on the head of the penis. It is the second-most common birth defect of the male reproductive system, affecting about one of every 250 males at birth. Roughly 90% of cases are the less serious distal hypospadias, in which the urethral opening is on or near the head of the penis (glans). The remainder have proximal hypospadias, in which the meatus is all the way back on the shaft of the penis, near or within the scrotum. Shiny tissue that typically forms the urethra instead extends from the meatus to the tip of the glans; this tissue is called the urethral plate.

<span class="mw-page-title-main">Chordee</span> Medical condition

Chordee is a condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. The curvature is usually most obvious during erection, but resistance to straightening is often apparent in the flaccid state as well. In many cases but not all, chordee is associated with hypospadias. This is not the same condition as Peyronie's disease, which involves curvature of the shaft of the penis most commonly due to injury during adult life.

<span class="mw-page-title-main">Penile fracture</span> Medical condition

Penile fracture is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis's corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vaginal intercourse, or aggressive masturbation. It sometimes also involves partial or complete rupture of the urethra or injury to the dorsal nerves, veins and arteries.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

Gender-affirming surgery for male-to-female transgender women or transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

<span class="mw-page-title-main">Dartos fascia</span> Layer of tissue

The dartos fascia, dartos tunic or simply dartos is a layer of connective tissue found in the penile shaft, foreskin and scrotum. The penile portion is referred to as the superficial fascia of penis or the subcutaneous tissue of penis, while the scrotal part is the dartos proper. In addition to being continuous with itself between the scrotum and the penis, it is also continuous with Colles' fascia of the perineum and Scarpa's fascia of the abdomen.

<span class="mw-page-title-main">Intersex medical interventions</span> Performed to modify atypical or ambiguous genitalia

Intersex medical interventions (IMI), also known as intersex genital mutilations (IGM), are surgical, hormonal and other medical interventions performed to modify atypical or ambiguous genitalia and other sex characteristics, primarily for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The history of intersex surgery has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, and create lifelong health issues. The medical interventions can be for a variety of reasons, due to the enormous variety of the disorders of sex development. Some disorders, such as salt-wasting disorder, can be life-threatening if left untreated.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Penile frenulum</span> Band of tissue under the glans penis connecting the foreskin to the ventral mucosa

The frenulum of the penis, often known simply as the frenulum or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa. In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection. In flaccid state, it tightens to narrow the foreskin opening.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

<span class="mw-page-title-main">Micropenis</span> Unusually small penis

A micropenis is an unusually small penis. A common criterion is a dorsal penile length of at least 2.5 standard deviations smaller than the mean human penis size. A micropenis is stretched penile length less than 2.5 cm in term infants, 2.6 cm in one-year-old, 3.5 cm in five year old, 3.8 cm in ten year old, and 9.3 cm in adults. The condition is usually recognized shortly after birth. The term is most often used medically when the rest of the penis, scrotum, and perineum are without ambiguity, such as hypospadias. A microphallus describes a medical term where other sections of genitallia are different, such as hypospadias or cryptorchidism. Micropenis incidence is about 1.5 in 10,000 male newborns in North America.

<span class="mw-page-title-main">Human penis size</span> Measurement of the human penis

Human penises vary in size on a number of measures, including length and circumference when flaccid and erect. Besides the natural variability of human penises in general, there are factors that lead to minor variations in a particular male, such as the level of arousal, time of day, ambient temperature, anxiety level, physical activity, and frequency of sexual activity. Compared to other primates, including large examples such as the gorilla, the human penis is thickest, both in absolute terms and relative to the rest of the body. Most human penis growth occurs in two stages: the first between infancy and the age of five; and then between about one year after the onset of puberty and, at the latest, approximately 17 years of age.

<span class="mw-page-title-main">Foreskin</span> Retractable fold of skin which covers and protects the glans of the penis

In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the glans by an elastic band of tissue, known as the frenulum. The outer skin of the foreskin meets with the inner preputial mucosa at the area of the mucocutaneous junction. The foreskin is mobile, fairly stretchable and sustains the glans in a moist environment. Except for humans, a similar structure known as a penile sheath appears in the male sexual organs of all primates and the vast majority of mammals.

<span class="mw-page-title-main">Webbed penis</span> Medical condition

Webbed penis also known as buried or concealed penis is an acquired or congenital condition in which the scrotal skin extends onto the ventral penile shaft. The penile shaft is buried in the scrotum or tethered to the scrotal midline by a fold or web of skin. The urethra and erectile bodies are usually normal. Webbed penis is usually asymptomatic, but the cosmetic appearance is often unacceptable. This condition may be corrected by surgical techniques.

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to not being circumcised, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

<span class="mw-page-title-main">Penile raphe</span> Line of tissue on the human penis

The penile raphe is a visible line or ridge of tissue that runs on the ventral (urethral) side of the human penis beginning from the base of the shaft and ending in the prepuce. The line is typically darker than the rest of the shaft skin, even though its shape and pigmentation may vary greatly among males. The penile raphe is part of a broader line in the male reproductive organs, that runs from the anus through the perineum and continues to the scrotum and penis, collectively referred to as median raphe. The penile raphe is homologous to the female labia minora.

References

  1. ↑ Chin, Tai-Wai (1 August 2016). "Buried penis". Formosan Journal of Surgery. 49 (4): 133–135. doi: 10.1016/j.fjs.2016.03.004 . ISSN   1682-606X.
  2. ↑ Zenaty, D.; Dijoud, F.; Morel, Y.; Cabrol, S.; Mouriquand, P.; Nicolino, M.; Bouvatier, C.; Pinto, G.; Lecointre, C.; Pienkowski, C.; Soskin, S. (November 2006). "Bilateral anorchia in infancy: Occurrence of micropenis and the effect of testosterone treatment". The Journal of Pediatrics. 149 (5): 687–691. doi:10.1016/j.jpeds.2006.07.044. ISSN   0022-3476. PMID   17095345.
  3. ↑ Fahmy, Mohamed (2017), "Phimosis and Paraphimosis", Congenital Anomalies of the Penis, Springer International Publishing, pp. 245–250, doi:10.1007/978-3-319-43310-3_38, ISBN   978-3-319-43309-7
  4. ↑ Cuckow, Peter M. (2010), "Embryology of the Urogenital Tract", Pediatric Urology, Elsevier, pp. 1–10, doi:10.1016/b978-1-4160-3204-5.00001-3, ISBN   978-1-4160-3204-5
  5. ↑ Redman, John F. (May 2005). "Buried Penis: Congenital Syndrome of a Short Penile Shaft and a Paucity of Penile Shaft Skin". Journal of Urology. 173 (5): 1714–1717. doi:10.1097/01.ju.0000154781.98966.33. ISSN   0022-5347. PMID   15821566.
  6. 1 2 3 4 5 6 Anandan, Lavanya; Mohammed, Aza (2018). "Surgical management of buried penis in adults". Central European Journal of Urology. 71 (3): 346–352. doi:10.5173/ceju.2018.1676. ISSN   2080-4806. PMC   6202613 . PMID   30386659.
  7. ↑ Frenkl, Tara L.; Agartwal, Saurabh; Caldamone, Anthony A. (February 2004). "Results of a simplified technique for buried penis repair" (PDF). The Journal of Urology. 171 (2): 826–828. doi:10.1097/01.ju.0000107824.72182.95. PMID   14713835. Archived from the original (PDF) on 2015-07-24. Retrieved 29 June 2014.
  8. ↑ Tang, SH; Kamat, D; Santucci, RA (July 2008). "Modern management of adult-acquired buried penis". Urology. 72 (1): 124–127. doi:10.1016/j.urology.2008.01.059. PMID   18343486.
  9. ↑ Chopra, CW; Ayoub, NT; Bromfield, C; Witt, PD (November 2002). "Surgical management of acquired (cicatricial) buried penis in an adult patient". Ann Plast Surg. 49 (5): 545–549. doi:10.1097/00000637-200211000-00017. PMID   12439025. S2CID   31208791.
  10. ↑ Crawford, BS (January 1977). "Buried penis". Br J Plast Surg. 30 (1): 96–99. doi: 10.1016/s0007-1226(77)90046-7 . PMID   836989.
  11. ↑ Donatucci, CF; Ritter, EF (February 1998). "Management of the buried penis in adults". J Urol. 159 (2): 420–24. doi:10.1016/s0022-5347(01)63939-9. PMID   9649254.
  12. ↑ Adham, MN; Teimourian, B; Mosca, P (September 2000). "Buried penis release in adults with suction lipectomy and abdominoplasty". Plast Reconstr Surg. 106 (4): 840–44. doi:10.1097/00006534-200009020-00014. PMID   11007398. S2CID   21513740.
  13. ↑ Shaeer, O; Shaeer, K (March 2009). "Revealing the buried penis in adults". J Sex Med. 6 (3): 876–885. doi:10.1111/j.1743-6109.2008.01162.x. PMID   19170865.
  14. ↑ Spinoit, Anne-Françoise; De Prycker, Stefanie; Groen, Luitzen-Albert; van Laecke, Erik; Hoebeke, Piet (2013). "New Surgical Technique for the Treatment of Buried Penis: Results and Comparison with a Traditional Technique in 75 Patients". Urologia Internationalis. 91 (2): 134–139. doi:10.1159/000351944. ISSN   1423-0399. PMID   23838371. S2CID   19458302.
  15. ↑ Burns, Hadley; Gunn, J. Stephen; Chowdhry, Saeed; Lee, Thomas; Schulz, Steven; Wilhelmi, Bradon J. (1 February 2018). "Comprehensive Review and Case Study on the Management of Buried Penis Syndrome and Related Panniculectomy". ePlasty. 18: e5. ISSN   1937-5719. PMC   5795411 . PMID   29467914.
  16. ↑ Vanni, Alex (2016-12-07). "Buried penis repair: Videos illustrate aesthetic, functional considerations". Urology Times. Retrieved 2020-02-24.
  17. ↑ Elist, James J.; Baniqued, Matthew; Hosseini, Alireza; Wilson, Steven K. (2019-08-05). "Correction of retractile penis with subcutaneous soft silicone penile implant". International Journal of Impotence Research. 32 (3): 317–322. doi:10.1038/s41443-019-0174-3. ISSN   1476-5489. PMID   31383992. S2CID   199450704.
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