Preparing for buried penis repair

Symptoms depend on how severe your case of buried penis is.

Symptoms can include:

• Urinary tract infections
• Sex organ pain (pain with erection, ejaculation)
• Trouble with erections
• Dribbling of urine
• Not being able to expose the penis (or pain when trying to expose the head of the penis)
• Infections of the head of the penis
• Greater risk for penile cancer
• Unusual or undesirable appearance of the penis

Buried penis has many causes, including:

Obesity: Obesity is the most common cause of adult-acquired buried penis. If the fat tissue extends beyond the head of the penis:

• Urine and moisture are hard to clear if the penis cannot be exposed.
• Trapping of moisture and urine leads to chronic inflammation.
• Inflammation and infection cause scarring of the genital tissue. This makes it harder to expose the penis. This condition is often called phimosis.

Lichen sclerosus: This is inflammation that affects the genitals and anal region and leads to scar tissue. It causes pain and irritation on the tip of the penis or foreskin. The skin may also have pale, white patches.

Genital lymphedema: This is swelling that leads to the scrotum getting bigger. Genital lymphedema is not common. It most often affects men who have had surgery or radiation for cancer that has spread into their lymph nodes.

Genital lymphedema is caused by a break in the lymphatic vessels that return fluid to the circulatory system. When those vessels are disrupted, fluid collects in the scrotum.

Circumcision: If too much skin is removed at the time of circumcision, this can bury the penis.

There are many ways to treat a buried penis. Most treatment decisions are based on the goals of the patient. Common goals include:

• Standing to urinate with an exposed penis
• Using the penis for sex
• Keeping the penis tip and scrotum clean after urination

Each person’s case and their goals will help decide the best surgical repair.

• If you’ve had surgery before, that may change your choices.
• If you have been circumcised, you may need a skin graft.

Buried penis can be repaired using conservative (less-invasive) treatment or with surgery.

A conservative treatment is also known as a less-invasive treatment. These are treatments that don’t involve major surgery. They include:

Weight loss: You may need to start a weight-loss program before surgery for buried penis. To help you get started, your urologist may:

• Refer you to a dietitian who can help you make a weight-loss plan
• Recommend bariatric surgery (gastric bypass) for weight loss

While weight loss is usually not enough to unbury the penis, it can help make your other treatments more effective.

Topical steroid cream: For men with a buried penis caused by a tight band of skin around the penis, a steroid cream can help “loosen” the skin.  

For this treatment to be successful, you will need to be motivated.

• You will apply the cream many times each day. To apply the cream, you will need to pull back the nearby tissue to expose your penis.
• It can take weeks or months to work.
• This treatment does not remove the extra tissue around the penis.

If the scar tissue band is too dense or has too much extra tissue, you may not be able to expose the penis enough for this treatment to be effective.

Penile skin incisions (also known as dorsal slit or revision circumcision): In this procedure, one or more cuts are made through the scar tissue of the skin of the penis, and the skin edges are arranged to open up the scar tissue and expose the penis.

This can be a good option for a person who has a mild case of buried penis or is not healthy enough to have a major surgery.

Some important things to know about penile skin incisions include:

• Like the topical steroid cream treatment, this procedure takes motivation. You will need to pull back on the nearby tissue to expose your penis many times daily.
• Minor skin separation is common and can be treated with antimicrobial ointment.
• This procedure does not remove the extra tissue around the penis. It exposes the penis by opening the scar tissue.

There are many different types of surgery to treat buried penis. The surgery you have will depend on the shape of your body and the health of the skin that covers your penis.

The main goal of the surgery is to expose the head of your penis. Exposure of the penis will help with urination, sexual function, and hygiene (keeping the area clean).

The procedures often required to help expose the head of the penis include:

Panniculectomy: The pannus is the tissue from the abdomen that can sometimes hang over the penis. For most buried penis repairs, this tissue will be left in place. Removing that tissue will require a plastic surgeon

Escutcheonectomy: The escutcheon is also called the mons pubis. It is the tissue just above the penis and below the pannus. This tissue is often removed during buried penis repair.

Scrotectomy/scrotoplasty: If the scrotum is enlarged and is burying the penis, some of the scrotal tissue will need to be removed.

Split-thickness skin graft: Once the penis has been exposed, your surgeon will determine if enough healthy skin is still on the penis.

Sometimes unhealthy tissue will need to be removed and then covered with skin from other areas of the body. In most cases, this skin can come from the tissue already being removed on the abdomen. Other times, the skin will come from the leg.

In the weeks before your surgery, you will undergo some tests to make sure you’re healthy enough for surgery. These tests can include:

• Electrocardiogram (ECG/EKG): This is to check that your heart is healthy enough for surgery.
• Blood work: Your blood is tested to make sure that your other organs are working the right way and to make sure that your blood levels are high enough.
• Chest X-ray: This is to check the health of your lungs.
• Medication review: This is to make sure your blood pressure is controlled and to check to see if you need to stop taking any medications (such as coumadin, aspirin, and clopidogrel) that can lead to bleeding before surgery.

You will also need to stop using all tobacco products before your surgery. This includes cigarettes, chewing tobacco, vaping products, and nicotine gum. A urine test is often done on the day of surgery to check this.

Days or weeks before your surgery, you will be given general details about your surgery appointment, including where and when to check in at the hospital.

Two business days before your surgery, you will receive a phone call with the exact time of your surgery.

Call us at 1-319-384-8008 if:

• It is 2 business days before surgery and you have not had a phone call.
• You have any other questions.

Most buried penis repair surgeries last 2 to 3 hours. An extra hour is needed for anesthesia, surgical positioning, and waking up.

Major complications are rare. Any surgery can have some risks, including:

Infection: You will get antibiotics before surgery. This lowers the risk of infection around the site of your surgery. Infections after urology procedures can happen in the incision (cut) or in the urine. They often happen 3 days after surgery.

Signs of infection include fevers, chills, and redness around the wound. With some infections, cuts may need to be opened for draining.

Skin separation: Skin infections, trauma, significant swelling, and tension on cuts can separate the skin and cause the wound to open. An open wound will need packing or use of a wound-vac, a device that uses suction to help a wound heal. Specially trained wound nurses will help with care instructions.

Bleeding: Injury to big blood vessels does not happen with this surgery, but there can be blood loss because of all of the small vessels affected. The rate of blood transfusions is low for this procedure. It’s normal to have bloody drainage from the cuts for a few days after the procedure.

Damage to nearby structures: The penis, testicular cords, and testicles could be damaged during surgery. They can be fixed during surgery.

Poor skin graft take: A skin graft on the penis may have difficulty healing properly. If the graft does not survive, there can be graft loss. This is often minor and only needs normal skin care.

Neurologic injury or positioning injury: During surgery, pressure points on your body are supported with pads, and your arms and legs are positioned to help avoid nerve injury. Even with this care, neurologic injuries can still happen. Most injuries will go away in the days and weeks after surgery. Some may need more rehab. Most will go away with time and rehab. These injuries are more common with longer operations that last 6 or more hours.

Need for more procedures: Even with your surgeon’s best efforts, a single surgery may not be enough. Fluid or too much tissue around the penis may create new issues that prevent the unburying of the penis. Some cases require follow-up procedures to help complete the treatment successfully.

Most people will spend 1 to 2 nights in the hospital.

If a wound-vac is needed in your recovery, you will stay 4 to 5 days.

People often leave the hospital when they can:

• Eat solid food
• Get out of bed and move around without help

The exact cut will look different for each person. It depends on their body. A large cut is made by the waist and the top of the scrotum. With a skin graft, that part of the penis will also have a cut.

Only if you need a catheter or a drain after the surgery.

Foley catheter: This will empty your bladder. It will stay in place until your penile bandage comes off.

Jackson-Pratt (JP) drain: This will empty fluid or blood from the surgery site. Most JP drains come out before you go home. Sometimes we will keep a drain longer and ask you to record the amount that drains each day. We will teach you how to care for your drain.

You go home with these medications:

Pain medications: Most people only need these for a few days.

Stool softeners: Anesthesia, pain, and pain medications can all slow the intestinal tract. Stool softeners help keep bowel habits normal. This is mainly helpful while on pain medications.

Antibiotics: Most people will only need these at the time of surgery

First visit after surgery: Your return will depend on what surgery you had. Most people will be seen in 5 to 10 days after surgery. The timing may also depend on what follow-up care you need.

• A Foley catheter will stay in until your penile dressing comes off. This could be in the hospital. It could also be at your first follow-up visit.
• If you leave the hospital with a surgical drain, it will be removed after the drainage has nearly stopped, usually within the first few days.
• Often we use skin staples to help close skin during healing. These are taken out 10 to 14 days after surgery.

Second visit after surgery: The timing of this visit can vary. Most people come back 2 to 3 weeks after surgery. This is to make sure you are healing well.

Wound nurses will help with care if there are problems with skin healing. It is important during healing to make sure the penis can be exposed.

We may ask you to come back for weekly visits to ensure a good repair.

Third visit after surgery: Three months after surgery you will come back for another visit. This is to make sure that:

• You are healing well.
• You have better hygiene.
• You have better working urination.
• You can have sex if you want to.

Any surgery with a skin cut can cause an infection. You must watch for signs of an infection. Some of the signs of infection are:

• Redness
• Swelling that gets worse
• Pus or murky drainage
• Worsening pain
• Skin separation

This is a major surgery. It will take a lot of time and energy to heal. In 2 to 3 months, your cuts will heal and the swelling will have gone down. Complex repairs can still change months after surgery. We will lead you through your recovery so you’ll know what to expect.