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Buried penis is a well known congenital anomaly in which the penis is normal in size but outwardly appears small. It goes by numerous other names such as concealed penis or inconspicuous penis. But regardless of the name in many patients the full size of the penis is hidden beneath the prepubic skin and fat. There are numerous causes of a buried penis (e.g., cicatricial after circumcision) but for the purposes of this discussion I will focus on the ones that are associated with a thick prepubic fat pad. In many of these cases in male children there is a high incidence of obesity although this is not true in every case.

In these patients there is always a combination of a tethered or shortened penis by abnormal fascial bands to the Dartos fascia. This prevents a normal forward extension of the penis which is magnified by a thick fat layer around it. This combination can produce symptoms of urinary stream obstruction, difficulty in maintaining hygiene and even urinary tract infections. But almost uniformly parents present the patient because of the small appearance of the penis.

Surgery is the only solution for the buried penis in children and typically focuses on penile release/lengthening combined with suprapubic liposuction. In my experience in working with my pediatric urologist colleagues, I typically perform the liposuction first. This is done through bilateral small incisions in the groin skin creases. A tumescent solution is initially infused and then liposuction is done with a 3mm or 4mm cannula. While the entire region from the penis up to the waistline is treated, it is important to put extra effort/concentration into the pubic fat pad around the base of the penis. This is where the fat is the most fibrotic and resistant to removal not to mention the area that would have the greatest benefit in improving penile show. Typical aspiration volumes run from 75c to 250cc. Even in small children I have never seen less than a 75cc aspirate obtained. This allow usually makes the full glans evident.

Thereafter the pediatric urologist performs the degloving of the penis, dissecting the skin and subcutaneous tissue from the penile body and reconstructing the penile skin. They typically fix the penile skin down to the pubic or Buck’s fascia. This provides maximal penile length exposure.

In the buried penis associated with a thick prepubic fat pad, the combination of penile release/lengthening and suprapubic liposuction has a synergistic effect. It is presumed although not fully known that the suprapubic liposuction has a long term and sustained effect.

Dr. Barry Eppley

Indianapolis, Indiana

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