Management of Buried Penis in Newborns
Observation without surgical intervention is the recommended approach for buried penis in newborns under 3 years of age, as this condition typically resolves spontaneously with growth and development. 1
Understanding Buried Penis in Newborns
Buried penis is a condition where the penis appears small or hidden despite having normal anatomical structures (urethra, erectile tissue, and glans). This condition can be:
- Congenital: Due to a paucity of penile shaft skin and short penile shaft 2
- Acquired: Sometimes occurring after newborn circumcision 1
Recommended Management Approach
Initial Assessment
- Perform a detailed physical examination of the penis and external genitalia, documenting the morphology and extent of the condition 3
- Rule out other penile anomalies or disorders of sexual development
- Ensure that bilateral testes are palpable (if not, immediate specialist referral is required) 3, 4
Management Strategy by Age
Newborns to 3 years old:
- Conservative management with observation is recommended
- 100% of infants under 1 year show buried penis appearance
- By 1-3 years, only 32.2% continue to have buried penis
- By age 3+, only 6.7% still have the condition 1
After age 3:
- Consider surgical referral if the condition persists
- Surgical intervention may be indicated for persistent cases causing:
- Voiding difficulties
- Urinary infections
- Significant psychological impact 5
Important Considerations
Avoid Premature Surgical Intervention
- Surgery is generally not recommended for buried penis in children younger than 3 years 1
- Natural growth and development, particularly after the child begins walking, typically resolves the condition
Circumcision Precautions
- If circumcision is being considered, evaluate carefully for buried penis first
- Circumcision in cases of buried penis may worsen the condition or create complications 6
- In cases of ambiguous genitalia or penile anomalies, circumcision should be postponed until complete evaluation 4
Follow-up Care
- Regular assessment during well-child visits
- Reassurance to parents about the typically benign and self-resolving nature of the condition
- Monitor for any urinary symptoms or infections
When to Refer to a Specialist
- If the condition persists beyond age 3
- If there are associated voiding difficulties or urinary tract infections
- If there are concerns about other genital anomalies
- Immediately if bilateral testes are nonpalpable 3, 4
The evidence strongly supports watchful waiting for buried penis in newborns and young children, with most cases resolving spontaneously without surgical intervention as the child grows.