A buried or hidden penis is an uncommon condition of young male children and teenagers. There are numerous reasons for a buried penis including scar retraction from a prior circumcision, childhood obesity, and a congenitally small or short penis. Regardless of the cause, a concealed penis is a potential problem for an unobstructed urinary stream as well as a source of social embarrassment.
In some patients, a suprapubic fat pad is present that can completely mask a penis on its own or, at the least, exacerbates an already partially buried penis. Obesity and the size of the mound often have a logarithmic relationship and any degree of being overweight makes concealment of the penis worse.
Numerous procedures are available to expose and lengthen the penis to make it more visible above the surface of the skin. The primary procedure is release and lengthening of the retracted penile shaft. Often, however, the enlarged suprapubic mound obscures the effect of penile lengthening making it less visible than it otherwise might be. In these cases, reduction of the suprapubic mound through liposuction is of invaluable assistance in maximizing the effect of penile lengthening.
I have performed over 100 suprapubic liposuction cases in buried penis patients, of which over 90% have been in children and teenagers. This procedure is always performed with a pediatric urologist of which I have been fortunate to have worked with some of the finest. The pediatric urologist first performs the release of the penis at which time I enter the case. Larger suprapubic mounds are first infiltrated with a tumescent solution but smaller ones are injected with a lidocaine and epinephrine solution only. Through small stab incisions in the groin creases, small caliber cannulas are used to aggressively suction the mound from the underside of the dermis to the base of the penis removing as much fat as possible. The pediatric urologist then returns to complete the procedure, finally securing the skin to the base of the penis. At the conclusion of the procedure, I like to apply compression which the patient will wear for one week after surgery.
The combination of penile lengthening and suprapubic liposuction is very effective for the correction of the buried penis deformity. Suprapubic liposuction adds little time and virtually no risk to the procedure. Families should be aware that the suprapubic liposuction is not covered by medical insurance even though the urologic portion may be eligible for benefits.
Dr. Barry Eppley
Indianapolis, Indiana