Buried penis, inconspicuous penis or hidden penis

This condition refers to a penis which appears to be small compared to a normal length and diameter of penis. This condition must be differentiated from small penis (micro-penis).  

Cause of hidden penis can be congenital or acquired.

This includes: 

1. Poor fixation of skin at the base of penis

2. Obesity

3. Trapped penis after circumcision

4. Trapped penis; combining causes listed above

The treatment of buried penis for children depends on the cause of the problem. Circumcision might make the buried penis more obvious.  This is usually a great concern for parents especially after circumcision. 

A number of conservative or surgical options are available for buried penis. 

Buried penis relating to obesity should have GP and dietitian advice and the underlying condition treated.  

Trapped penis due to scaring can be treated with steroid cream or simple incisions at constricting scarred-ring. This will reduce the formal redo circumcision to 70-80%.  The trapped penis can be avoided if instructions are followed fully after circumcision in children with potential mild to moderate buried penis. 

Congenital severe buried penis required surgical operation under General Anesthesia. The indications and timing for this operation remain controversial. In moderately severe cases, it’s my practice to operate them when they are 3-5 years old, unless they have symptoms of urinary tract obstruction. 

Further advice can be obtained after I can assess the severity of the problem.

Audit of adult circumcisions by forceps guided method (Glue and stitches) by Dr Khan at Thornhill Circumcision Centre, Luton, Bedfordshire

I have audited 172 adults circumcision in one year - Jan 2013- Dec 2013 at Thornhill Clinic, Luton 

Indications

Medical due to phimosis - Balanitis Xerotica Obliterans (BXO)  n=20

Cultural/hygiene/religious n=152

Complications

Infection n=6 (3.4%) treated with antibiotics

Minor bleeding n=5 (3%) conservatively treated

Wound gap n=2 (1%), topical antibiotics

Overall, Circumcision with Glue is better than stitches because of less pain, less infection and less scaring. Glue is waterproof so that patients can have a shower next day. 

Optimal age for non-therapeutic male circumcision using Circumplast and Plastibell devices in a community clinic is under 6 months.

PURPOSE

Non-therapeutic male circumcision is performed across the country at different ages according to parents’ choice, religion, social and cultural attitudes. There is no national medical guidelines for parents, physicians and independent providers. Our aim is to review the outcome of circumcision in a community clinic to find out the appropriate age for circumcision.

MATERIAL AND METHODS

We have reviewed the outcome of non-therapeutic male circumcision (n=1387) over a 1 year period (May 2014 to April 2015) in a community clinic, performed under local anaesthesia, using Circumplast® (n=208) and Plastibell® (n=1179) devices. Data was collected prospectively and early postoperative complications were compared in children under 6 months (Group A) and 6 to 110 months of age (Group B). Follow-up consultations were arranged if required.

RESULTS

Mean age was 1.6 ± 0.04 months (median 1.1) in group A and 38 ± 1.6 months (median 29) in group B. Complications was significantly lower in group A (7.1% n=74/1038) versus group B (26.7% n=93/349) (p<0.5). Ring impaction/migration was significantly lower in group A versus group B (2.6% vs 23% n= 27 vs 81, p<0.5) respectively. Postoperative use of antibiotics was lower in group A versus group B (4.3% vs 6.9% n=45 vs 25) but not statistically significant (P>0.05). Follow-up was required significantly less in group A (25% vs 52%, p<0.5) and mean follow-up was 24 days (range 1 to 305) and 14 days (range 1 to 373) in group A and B respectively.

CONCLUSIONS

Incidence of complications in circumcision for 6 months olds is significantly lower when compared to 6 to 110 months old children.  We can conclude that under 6 months is the optimal age for non-therapeutic male circumcision in a community clinic using Circumplast® and Plastibell® devices.

This study was done at Thornhill clinic.  

Source: 27th ESPU Congress - Harrogate, England, UK - 2016

Consultation for baby circumcision  

Dr Khan comments: In my experience of 22 years, ideal age of infant circumcision is under one month of age. Healing is quicker and less complications at this age.  

Informed consent for adult circumcision

We provide the patient with adequate information about the procedure ahead of time. Circumcision is an irreversible procedure and makes the head of penis exposed permanently. The patient should be told about the risks of bleeding,  bruises, haematoma formation, infection, inadvertent damage to the glans, removal of too much or too little skin, lymphoedema, aesthetically unpleasing results and a change of sensation during intercourse. The patient should also be informed that, during the postoperative period, erections can cause pain and discomfort; very small chances of disruption of wound which might require redo operation. Full recovery following circumcision generally requires four to six weeks of abstinence from all sexual stimulation and sexual activity. Swimming and weight lifting should be avoided for 2-3 weeks. 

We provide consent form ahead of the appointment by an email. 

Dr Khan will discuss further details before the circumcision.

The British Association of Urological Surgeon has issued an informed consent form for the adults.