In this Q&A session, Detlev Erdmann, MD, PhD, MHSc, of Duke Plastic Surgery, discusses the causes of and treatments for buried penis disorder.Detlev Erdmann, MD, PhD, MHSc

What does the term "buried penis" refer to?

Buried penis is a term that describes a penis of normal length that is buried below the surface of the pubic skin or within its own excessive shaft skin.

It also refers to a partially or totally obscured penis caused by obesity, an overly aggressive circumcision, or other underlying conditions.

What causes this condition?

Buried penis can occur in children as a very rare congenital disorder, but most commonly it presents as an acquired condition during adulthood.

Some causes of buried penis include obesity, radical circumcision, or lymphedema (swelling that is caused by a blockage in your lymphatic system).

Obesity is generally a partial contributor in many of the adult patients who are referred for buried penis syndrome. As the skin and fat in the area above the pubic area increases, penile length is lost and the penis can appear to be buried.

Additionally, abdominal fat can hang over the penis, creating a moist environment conducive to bacterial and fungal growth. This environment creates a cycle of chronic infections, skin breakdown, chronic inflammation, and scar contracture that leads to a buried or trapped penis. As the scar contracts, the skin above the penis is transported over the shaft and glans and the shaft skin is pulled up and into itself. The scrotum may also be involved in this process.

Some patients who underwent a "radical" circumcision may end up with a buried penis. In this instance, the suture line from the circumcision constricts during the healing process and forms a scar which results in lymphedema and trapping of the penis.

In addition to radical circumcision, other forms of genital trauma may lead to trapping of the penis. Genital skin loss or hypertrophy for any reason (i.e., burns, infection, or other causes) may lead to a buried penis as scar contracture occurs.

How common is this disorder?

This condition is rare, but the instances of buried penis are expected to rise as the epidemic of obesity becomes more prevalent in our society.

How do you treat this condition at Duke?

Duke plastic surgeons and urology surgeons collaborate to offer reconstructive surgery for patients with buried penis.

The goal of treatment is to restore appearance and function, and surgical treatment plans are tailored to each patient’s needs and condition. We offer preoperative counseling to ensure the patient understands the implications and goals associated with surgical correction.

Important considerations in surgical reconstruction include the potential need to remove the affected tissues, including penile shaft "degloving," reduction scrotoplasty, and to perform adjunctive lipectomy, local flaps, skin grafting, or a combination of these techniques.

What outcomes can patients expect from treatment?

Over the course of treatment, the appearance of the penis and scrotum will be reconstructed. Urination and sexual function will likely be restored, although long-term follow-up scientific studies are lacking.

Why should patients come to Duke for treatment?

Duke surgeons are leaders in the correction of buried penis. Our systematic approach to treatment has been published in the medical literature. Patients from outside North Carolina have been referred on a consistent basis to our program.

For more information about the management of buried penis, see the article abstract "Management of 'Buried' Penis in Adulthood: An Overview" on PubMed.

For more information about treatments for buried penis disorder, please contact Detlev Erdmann, MD, PhD, MHSc, or Michael Ferrandino, MD.