Adult Acquired Buried Penis: A Hidden Problem in Obese Men

Abstract

Buried penis is a condition where the penis is hidden by abdominal or suprapubic skin or fat. In adult men, buried penis occurs as an acquired condition most commonly caused by morbid obesity. The clinical characteristics of three obese men with adult acquired buried penis are described and the associated features of the buried penis are reviewed. In addition to morbid obesity, a buried penis can result from other etiologies, such as hidradenitis suppurativa, iatrogenic causes such as elective surgeries, infections, lichen sclerosus, penoscrotal lymphedema, and traumatic events. Lower urinary tract symptoms, such as voiding, and post-voiding problems are the most common presenting complaints; however, bacterial and fungal infections, phimosis, psychological issues, and sexual dysfunction, are also buried penis-related symptoms. The evaluation of a man with adult acquired buried penis begins with a detailed history for condition-related symptoms. Examination of the patient, both standing and supine with an attempt to demonstrate the penis using digital compression of the surrounding skin and fat, should be performed to determine the extent of the problem and whether comorbid conditions-such as infection and lichen sclerosus-are present. Both buried penis and lichen sclerosus can predispose to the development of penile squamous cell carcinoma; the diagnosis of this tumor can be delayed in men with adult acquired buried penis since an adequate penile examination is difficult or impossible. A multidisciplinary approach-including surgeons, primary care physician, registered dietitian nutritionist, and psychiatrist-should be considered for a patient with a buried penis. The surgical management is individualized and based on not only the extent of the problem but also whether an associated condition, such as urethral stricture, is present. Most patients are pleased with the functional and aesthetic outcome following surgery.

Good Things Don't Always Come in Small Packages

“…Adult acquired buried penis syndrome is a medical condition in which the penis is either partially or fully buried beneath the skin or subcutaneous fat of the scrotum or abdomen. In adults, it is most commonly caused by morbid (Class 3) obesity 71. The penis appears to have retreated into the scrotum, and may appear as a turtle's head retracting into its shell.…”

“…In adults, it is most commonly caused by morbid (Class 3) obesity. 71 The penis appears to have retreated into the scrotum, and may appear as a turtle's head retracting into its shell. In addition to its characteristic appearance, a buried penis may create lower urinary tract symptoms such as weak urinary stream and postvoid dribbling.…”

“…In addition, management of odor sin skin folds can be enhanced with use of silver-based wicking materials (eg, Inter-Dry Ag, Coloplast, Minneapolis, Minnesota) applied to skin folds (Figure 9). Class 3 obesity may also result in full coverage of the penis requiring extra care when cleansing the penis and scrotum 71 (Figure 8).…”

Lymphatic Mapping in the Repair of Adult-acquired Buried Penis: Proof of Concept

“… 2 The incidence of AABP, though incompletely understood, is thought to follow the rising trends of obesity, which has been increasingly seen by reconstructive urologists. 3 Surgical repair of AABP has become the standard of care in the management of this condition, with surgical complexity associated with disease classification. 4 The goal of this surgery is to improve sexual function, urinary difficulties, skin irritation, and associated depression and decreased quality of life.…”

“Postoperative Outcomes Following Buried Penis Reconstruction: A Single-Institution Experience Using the Wisconsin Classification System”

“…Adult acquired buried penis (AABP) is a chronic and debilitating condition that can lead to functional, aesthetic, and hygiene- and pain-related concerns. Although it is most often attributed to obesity, 1 other causes of AABP include penile skin deficiency, scarring, and lymphedema. 2,3 In this condition, a normal-sized, nonerect penis becomes concealed, or “buried,” within scar tissue and/or the suprapubic fat pad.…”