London Circumcision centre

The buried penis, or hidden penis

Concealed or buried penis is a congenital condition in which the penile shaft is concealed into the surface of pubic skin and fat. On physical examination, the penis is buried below the surface of pubic skin and fat, but can be palpated and visualized by applying pressure on the opposite side of the base of the penis. If this is mild form, we can proceed to do circumcision in earlier age. Circumcision can be postponed if this condition is moderate to severe form. Buried penis may become 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 prior to the insertion of a Plastibell or Circumplast, 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 get older, and after beginning to walk, the appearance usually turns out to be normal. This resolution may be due to growth and/or maturation alone.

Among possible results are:

  1.  As the Plastibell/Circumplast device is buried, it sometimes does not have a chance to heal properly and the ring will not fall off.
  2. The skin which has been left below the ring can become attached to the penis and can require additional surgical attention to be separated.
  3. The area around the wound is not open to the air and may get infected.
  4.  This is a difficult area which 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 very important when bathing to expose the entire penis and wash it well before allowing it to retract again.
  5. This condition, called 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 own GP for further management in 10% cases. (THE JOURNAL OF UROLOGY 181, 1841-1843, 2009)

 Based on our experience, we recommend circumcision if parents understand the condition and willing to follow aftercare instruction meticulously after circumcision. It is important that parents take an active role when male children with buried or hidden penis go home, to help to achieve a good result.

 Following instructions are to follow:

  • After 3 days the ring has fallen off, regular retraction of the outer layer of skin should be performed after by applying pressure on the opposite side of the shaft base regularly for 3-6 months.
  • 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 head of penis.
  • Continue to push back the foreskin & expose the glans and apply Vaseline cream continue for 3-6 MONTHS.

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

 

Dr Khan is expert in the management of buried penis and its complications