Buried penis repair: restoring the penile skin

Purpose of the operation

In a buried penis, the penis itself is a normal size, but the skin and surrounding tissue pull it inward and hide it. The operation brings the penis out, anchors the skin at its base and covers it with enough skin. This makes hygiene easier and prevents inflammation and difficulty peeing.

The penis is measured first. If it is truly small, that is a micropenis, which is treated in a completely different way.

Who needs it?

• the head of the penis stays under the skin, hygiene is difficult and balanoposthitis keeps coming back,
• urine collects under the skin, the foreskin balloons and the stream sprays,
• after circumcision, a scar pulls the penis inward and squeezes it (trapped penis),
• the skin between the penis and the scrotum forms a web (webbed penis),
• an older boy or teenager is significantly worried about how it looks.

Mild cases without symptoms, especially those linked to fat in the lower abdomen, are watched. As children grow and weight normalizes, the penis often looks better.

Why not a standard circumcision first?

In a buried penis there is already too little skin. A standard circumcision removes part of it, and the scar along the cut can pull the penis further inward. The foreskin is the main tissue used to cover the penis in the repair. That is why circumcision is done as part of this operation, not separately.

How is it done?

The operation is done under general anesthesia with local pain relief (anesthesia in children) and usually takes 1–2 hours.

1. The skin is separated from the shaft of the penis.
2. Tight, abnormal tissue bands that pull the penis inward are removed.
3. The skin is stitched at the base of the penis on the pubic and scrotal sides so it does not pull back in.
4. In a webbed penis, the angle between the penis and the scrotum is corrected.
5. The shaft is covered with the inner layer of the foreskin, and extra skin is removed.

In obesity-related forms, extra fat in the lower abdomen is sometimes reduced. For a penis trapped after circumcision, the scar ring is removed and the skin cover is rebuilt.

After surgery

• A firm dressing stays on the penis for 2–5 days. Sometimes a urinary catheter is left for 1–2 days.
• Most children go home the same day or the next day.
• Swelling is normal. Swelling of the penile skin can last several weeks and goes down gradually.
• After the dressing comes off, warm baths and ointment are usually advised, as the doctor instructs.
• Paracetamol or ibuprofen in an age-appropriate dose is enough for pain.
• Avoid ride-on toys (bikes, rocking horses, ride-on cars) for several weeks.

More: care after surgery.

Results and follow-up

In most boys the penis looks normal and the hygiene problems resolve. If extra weight remains or increases after surgery, the penis can become partly hidden again. In obesity-related forms, maintaining a healthy weight can help preserve the surgical result. Check-ups are done a few weeks and a few months after surgery.