Management of "buried" penis in adulthood: an overview.

BACKGROUND: The condition of "buried" penis may arise from several factors. Although the pediatric form is a rare congenital disorder, it may become an acquired condition in adulthood, most commonly from obesity, radical circumcision, or penoscrotal lymphedema. As obesity has become a national epidemic, the incidence of this phenomenon will inevitably increase. The purpose of this article is to present current strategies in the management of this physically and psychologically debilitating condition. METHODS: A literature review of the surgical management of buried penis was obtained mainly in the plastic surgery and urology literature (PubMed), from 1977 to 2007. RESULTS: Several risk factors were identified in adult patients with buried penis, including morbid obesity and diabetes mellitus. Multiple techniques for release and reconstruction are described, including primary closure, Z-plasty, and skin resurfacing, all of which may or may not include a lipectomy. Recent publications focus on resurfacing with split-thickness skin grafts and negative-pressure dressings. These techniques have been successful in terms of graft survival and long-term cosmetic result. CONCLUSIONS: Buried penis is an unusual, difficult-to-treat condition that presents a unique challenge to the plastic surgeon and the urologist. Predisposing factors such as morbid obesity and diabetes mellitus are becoming increasingly prevalent, which suggests a potential increase in the incidence of this condition. Although no specific approach may be applicable to all patients, a combination of various techniques may be applied. In complicated and severe cases, a split-thickness skin graft to the penile shaft, reduction scrotoplasty, suction-assisted lipectomy, and/or surgical lipectomy, such as panniculectomy, may be indicated. Therapy adapted to the individual patient can result in high rates of successful reconstruction with acceptable cosmetic results.