Comprehensive Physician Examination for Buried Penis
A detailed physical examination of the penis and external genitalia is essential for proper evaluation of buried penis, recording morphology, size, location, and extent of involvement of penile structures. 1
Initial Assessment
History
- Duration and progression of the condition
- Presence of associated symptoms:
- Voiding difficulties (inability to void standing)
- Sexual dysfunction
- Hygiene issues
- Pain or discomfort
- Recurrent infections
- Underlying medical conditions:
- Diabetes mellitus
- Obesity
- Lichen sclerosus
- History of genital surgeries
- Hidradenitis suppurativa
Physical Examination Components
General Examination
- Body mass index (BMI) and assessment of obesity
- Presence of abdominal pannus and its relationship to the penis
- Evaluation of the escutcheon (suprapubic fat pad)
Genital Examination
Penile Assessment:
- Visibility of the penis in standing and supine positions
- Ability to manually expose the penis by retracting surrounding tissue
- Presence and extent of penile skin abnormalities:
- Lichen sclerosus
- Scarring
- Contracture
- Inflammation
- Glans condition and urethral meatus position
Surrounding Structures:
- Condition of the scrotum and scrotal skin
- Presence of scrotal lymphedema
- Integrity of penopubic and penoscrotal angles
- Evaluation of tethering or adhesions
Classification Assessment
Document the buried penis according to anatomical involvement:
- Status of the abdominal pannus
- Condition of the escutcheon (suprapubic fat pad)
- Integrity of penile skin and fascial attachments
- Condition of scrotal skin 2
Functional Assessment
- Ability to void standing
- Sexual function capability
- Hygiene maintenance ability
- Quality of life impact
Diagnostic Testing
- Imaging: Consider MRI or ultrasound of the penis when there is uncertainty regarding corporal involvement or feasibility of organ-sparing surgery 1
- Biopsy: Obtain pretreatment biopsy when malignancy is suspected or nonsurgical treatment is planned 1
- Photography: Standardized preoperative photos from multiple angles to document the condition and assist with classification 2
Special Considerations
Pediatric vs. Adult Examination
- In children: Focus on congenital factors, developmental issues, and impact on urination
- In adults: Greater emphasis on obesity-related factors, skin conditions, and sexual function
Malignancy Screening
- Careful inspection for suspicious lesions
- Biopsy of any concerning areas, particularly in patients with chronic inflammation or lichen sclerosus
Documentation Requirements
Document the following in the medical record:
- Detailed description of physical findings
- Classification of buried penis type
- Functional limitations
- Photographs (with patient consent)
- Proposed management plan
This comprehensive examination approach ensures proper evaluation of all aspects of buried penis, facilitating appropriate treatment planning and surgical intervention when indicated.