Surgical Correction of the Buried Penis: Description of a Classification System and a Technique to Correct the Disorder

A practical approach for the correction of iatrogenic penile skin loss in children: Scrotal embedding technique

“…[4] This concealment may lead to secondary phimosis, recurrent balanitis, voiding problems, sexual dysfunction, and social embarrassment. [5] Maizels et al [5] proposed a classification system for concealed penis. It consists of three distinct subtypes, including buried, webbed, and trapped penis.…”

“…Excessive suprapubic adipose tissue and inadequate attachment of the penile skin to the shaft may contribute to these underlying disorders. [5] Iatrogenic cases in children commonly result from radical circumcision. Excessive resection of the foreskin without fixation of the penile skin to the Buck's fascia can result in deficient penile shaft skin, which worsens the condition and leads to scarring.…”

Editorial comment

“…As a consequence of these hypotheses, many different procedures for the correction of the buried penis have been described. These include the release of penile shaft adhesions [2±4, 6,7,9,11], degloving of the penis to Buck's fascia [3,4,9,12,14,15], dissection of the root of the penis [4,6,7,14], division of the suspensory ligament of the penis [5,10], preputial unfurling [7,9,11,12], anchoring of the skin to the base of the penis [4±7,11±13,14,15] or even to the symphysis pubis [10], open lipectomy [4,5,10,13,14], various`Z'-plasties [4,5,9,13,15] and skin¯aps [2,3]. Both ventral [6,7,15,16] and dorsal [2,5,11,14,15] approaches are described.…”

Common urological problems in children: prepuce, phimosis, and buried penis

“…For the complete type, the phallus is completely invisible and the glans is covered only by prepuce. Maizels et al 58 further elaborated in 1986, offering new classifications as 'buried penis' (patients with redundant suprapubic fat and/or lack of penile skin anchoring to deep fascia), 'webbed penis' (scrotal skin webs the penoscrotal angle to obscure the penis), 'trapped penis' (the shaft of the penis is entrapped in the scarred, prepubic skin following trauma/overzealous circumcision), 'micro-penis' (a normally formed penis that is less than two standard deviations below the mean size in the stretched length), and 'diminutive penis' (a penis that is small and/or malformed as a consequence of epispadias/exstrophy, severe hypospadias, disorder of sexual differentiation, or chromosomal anomalies). O'Brien et al 59 described another condition called 'congenital megaprepuce' in 1994 that includes a phimotic ring and large preputial sac.…”