Buried penis

Buried penis is more common in obese children and obese men. Most patients have normal penis size and length.  It is caused by an excessively thick subcutaneous fat anterior to pubic area that separates the penile skin from the penile shaft, a degloving phenomenon.  As a result, the normal size penis is buried inside a thick fat pad forming buried penis.

Buried penis may affect the patients as in the followings:

• Buried penis may lead to inaccurate urine stream or urine stream bifurcation resulting in urine wetting the patients' body, clothing or the surrounding environment.
• Patients with buried penis usually cannot retract and clean their foreskin and glans of penis.  There is often urine and dirt accumulating between the glans of penis and prepuce resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitisor even urinary tract infections. Through sexual intercourse, the bacteria inside the foreskin can be passed to patients' sexual partners causing vaginitis, pelvic inflammatory disease, or urinary tract infections.   The bacteria of the female sexual partners can pass her bacteria to the patients with buried penis causing unpleasant odors, balanitis, posthitis or even urinary tract infections.
• Patients with buried penis often had easy slippage of condom or difficulty in wearing condom.
• Buried penis will affect ejaculation.  The ejaculated semen is usually trapped between prepuce and glans of penis.  This in turn may affect fertility.
• As the glans of penis of patients with buried penis is nearly always covered by foreskin, the glans of penis is usually more sensitive or even hypersensitive comparing to normal guys.  The glans of penis with hypersensitivity, once exposed, may result in premature ejaculation. After circumcision, when the glans of penis is normally exposed, the skin of the glans of penis thickens with time.  Skin thickened glans of penis will become less sensitive, circumcision may improve premature ejaculation.
• Pediatric patients with buried penis usually cannot retract and clean their foreskin and glans of penis.  There is often urine and dirt accumulating between the glans of penis and prepuce resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitisor even urinary tract infections.  After infection and inflammation, fibrosis, scar and tissue contraction may set in the prepuce, glans of penis or the shaft of penis, affecting urination and growth of the penis.
• Patients with buried penis have ambiguous external sexual features and short looking penis.  Patients may experience a negative psychological impact.

Traditional Buried Penis Surgery

Traditional Buried Penis Surgery: Circumcision + Suprapubic fat excision + adhesiolysis + penile skin refashioning and fixation

Traditional buried penis surgery involves (1) circumcision, (2) suprapubic fat excision wide excision (3) adhesiolysis and (4) penile skin refashioning and fixation.

Tradition buried penis surgery needs to excise 1- 5Lb of suprapubic fat and skin. It is a major and extensive surgery. A drain is inserted to the operating tissue to drain the post operative tissue fluid below the skin and the drain is going to be removed in few days time. Penile skin refashioning and fixation involves returning the loosen penile skin to its proper position on the penile shaft and fixing the skin properly.

Traditional Buried Penis Surgery has more bleeding, and more postoperative pain. It requires cleansing of wound with distilled water, normal saline or antiseptic. Patients usually need to rest for at least 1 - 2 weeks after surgery before going back to work / school. Patients can perform mild exercise 4 weeks after surgery. Sexual intercourse can be resumed 4 - 6 weeks after surgery.

New and simplified Buried Penis Surgery

New and simplified Buried Penis Surgery: Laser Circumcision + adhesiolysis + suprapubic fat excision / reposition + penile skin refashioning and fixation

The New and simplified Buried Penis Surgery is to re-attached the loosen penile skin to the penis with (1) laser circumcision, (2) adhesiolysis, (3) returning or removing the intervening suprapubic fat, and (4)penile skin refashioning and fixation.

Circumcision is nearly always performed with buried penis surgery because it creates a window to access the deeper structures. Through this tiny circumcision opening, experienced surgeons can perform adhesiolysis, removal or returning of suprapubic fat, and penile skin refashioning and fixation. The wound is closed with tiny absorbable sutures and reinforced with cyanoacrylate glue.

During the new and simplified buried penis surgery, CO2 laser is being used and it has the advantage of less intraoperative bleeding and less postoperative pain. Post operatively, patients need no wound cleansing after each urination. The new generation buried penis has the advantages of low to nearly zero post-operative wound pain. The cut wound is neat and tidy. All patients need to do is to keep the wound dry. Patients can return to school or work in 1-2 days time. Normally moderate exercise could be performed 2 - 4 weeks afterwards. As the wound heals, sexual activities could be resumed 4 - 6 weeks after the new generation laser circumcision.

New generation of sterile medical super-glue

New generation of sterile medical super-glue is a medically grade glue being used over the wound and it is made of cyanoacrylate (an acrylic acid glue). It is being used to apply on the surface of the wound to hold the wound together, and it forms a protective layer to keep the wound away from moisture (water-proof) and bacteria (anti-bacterial). With the use of this super-glue, the risk of post-operatively bleeding and burst wound, esp. during erection, would be minimized. There is no need for regular wound cleansing every time after urination. Keeping the wound dry is essential. No removal of glue is needed as the glue wound dislodge spontaneously in a few weeks time with the normal skin exfoliation after surgery.

Precautions for buried penis surgery

For the new and simplified buried penis surgery performing in the hospital:

Before surgery :

• Inform doctor for special medical condition(s) and current drug(s) use
• Shave the pubic hair and have a shower in the morning before surgery to reduce the bacterial load around the wound
• Keep nil by mouth six hours before operation
• Void immediately before surgery and relax

After surgery:

• Take a rest and learn the steps for wound care
• Expect to leave on the same day or the day after
• Wear tight underwear (for reduction of penile movement) and loose pants
• Follow up in the clinic 3-7 days after operation
• Keep wound dry all the time

For the new and simplified buried penis surgery performing in the clinic:

Before surgery :

• Inform doctor for special medical condition(s) and current drug(s) use
• Shave the pubic hair and have a shower in the morning before surgery to reduce the bacterial load around the wound
• Have a light breakfast before operation
• Void immediately before surgery and relax

After surgery:

• Take a rest of about 15-30 minutes
• Expect to leave after learning the steps of wound care
• Wear tight underwear (for reduction of penile movement) and loose pants
• Follow up in the clinic 3-7 days after operation
• Keep wound dry all the time

Please seek medical advice if you have any problem about the wound.