Buried penis

Buried penis (Canceealed or hidden penis) is a congenital condition in which the penile shaft is hidden into the surface of pubic skin and fat. On physical examination, the penis is buried below the surface of pubic skin and fat. Still, it can be palpated and visualised by applying pressure on the opposite side of the base of the penis. If this is mild, we can proceed to circumcision earlier. Circumcision can be postponed if this condition is in moderate to severe form. The buried penis may worsen after circumcision, mostly during infancy, presumably due to pubic fat.

The surgeon can do the operation by pushing the surplus skin back and exposing the penis by the use of forceps before the insertion of a Plastibell or Circumplast device, this is temporary, and as soon as the operation is over, the penis reverts to its place buried behind a mass of suprapubic fat.

As children grow and begin to walk, their appearance usually turns out to be expected. This resolution may be due to growth and maturation alone.

Among possible results are:

1. As the Plastibell/Circumplast device is buried, it sometimes does not have a chance to heal correctly, and the ring will not fall off.

2. The skin left below the ring can become attached to the penis, requiring additional surgical attention to be separated.

3. The area around the wound is not open to the air and may get infected.

4. This problematic area could become unclean without the parents pushing back the skin around the penis. Bathing in salt water is inadequate if the area around the penis is not exposed; it is essential when bath to expose the entire penis and wash it well before allowing it to retract again.

5. This condition, called a buried penis, usually resolves in 90% of cases when the child gets around 1-3 years of age. However, a child may require a referral to a Paediatric Urologist by your GP for further management in 10% of cases. (THE JOURNAL OF UROLOGY 181, 1841-1843, 2009)

 Based on our experience, we recommend circumcision if parents understand the condition and are willing to follow aftercare instructions meticulously after circumcision. Parents must take an active role when male children with buried or hidden penises go home to help to achieve a good result.

 The following instructions are to follow:

• After three days, the ring has fallen off. After applying pressure on the opposite side of the shaft base regularly for 3-6 months, the outer layer of skin should be retracted regularly.

• Make sure the skin on the penis can move below the head of the penis up to the groove (sulcus). This is also called the glans. Sometimes, the skin moves up over the glans and sticks to it.

• With your thumb and forefinger, push down on either side of the base of the penis till the glans “pops out” above the skin. Apply Vaseline cream at the head of the penis.

• Continue to push back the foreskin & expose the glans, and apply Vaseline cream for 3-6 MONTHS.

Arrange for a review with the London Circumcision Centre at 2-4 weeks with our Paediatric Urologist if required.