What is the best treatment approach for a patient with a buried penis, potentially caused by obesity, diabetes, or previous surgeries?

Buried Penis: Treatment Approach

Surgical correction is the definitive treatment for buried penis in both children and adults, and obesity alone should not delay intervention—proceed with penile degloving, basal anchoring, and split-thickness skin grafting, combined with suprapubic lipectomy in obese adults. 1, 2

Initial Assessment and Patient Selection

Key clinical features to identify:

• Complete or partial entrapment of the phallus beneath suprapubic or scrotal skin 3
• Inability to void standing, urinary dribbling, and post-void problems 3
• Chronic moisture leading to bacterial/fungal infections, skin breakdown, and phimosis 3
• Examination both standing and supine with digital compression to demonstrate actual penile length 3
• Screen for comorbid conditions: diabetes mellitus (present in 71% of cases), morbid obesity, lichen sclerosus, hidradenitis suppurativa 4, 3

Critical pitfall: Buried penis with lichen sclerosus predisposes to penile squamous cell carcinoma, but diagnosis is often delayed due to inability to adequately examine the penis—maintain high index of suspicion and biopsy any suspicious lesions. 3

Surgical Algorithm

Core surgical principles (applies to all patients): 1, 4, 2

1. Penile degloving to release entrapped phallus 1
2. Resection of scar contracture of distal soft tissue and skin envelope (suspensory ligament release rarely needed) 4
3. Basal anchoring of penis to pubis to prevent recurrence 1, 2
4. Split-thickness skin grafting for penile shaft coverage 1, 2

For obese adults, add: 1, 2

• Suprapubic lipectomy/panniculectomy to remove excess abdominal fat pad 1, 2
• Scrotoplasty as needed 5

For patients with previous failed repairs:

• Expect extensive contracture requiring more aggressive resection 4
• May require reoperation for adequate coverage 4

Multidisciplinary Coordination

Essential team members: 3

• Urologist and plastic surgeon for coordinated reconstruction 2
• Primary care physician for medical optimization 3
• Registered dietitian nutritionist 3
• Psychiatrist for psychological support 3

Expected Outcomes and Postoperative Course

Hospital stay: 1

• Children: average 3 days 1
• Adults: average 5 days 1

Complications: 1, 2

• Superficial wound problems and dehiscence are not uncommon but generally resolve 1, 2
• Minor skin breakdown may occur 1
• Infection risk elevated in diabetic and obese patients 2

Functional outcomes: 4, 2

• All patients regain potency postoperatively 4
• Full restoration of urinary and sexual function consistently reported 2
• Substantial quality of life improvements in all studies 5
• High patient satisfaction with both functional and aesthetic results 1, 2

Critical Management Principles

Do not delay surgery for weight loss. The traditional approach of deferring surgery until weight reduction is achieved forces patients to live with significant physical and psychological morbidity for years—obesity itself should not be a contraindication to surgical intervention. 1

Adherence to basic reconstructive principles yields high success rates when appropriate planning is performed, even in morbidly obese patients with multiple comorbidities. 4

Wound healing concerns in diabetics require vigilance but should not preclude surgery—optimize glycemic control perioperatively and monitor closely for wound complications. 5