Surgery for Buried Penis and Scrotal Lymphedema

Overview

What is buried penis?

Buried penis is a condition that can affect boys or adult men. In this condition, the penis is of normal size but is hidden under the skin of the abdomen, thigh or scrotum (sac beneath the penis that holds the testicles). The penis is concealed in tissue above the pubis as a result of poor fixation of the skin at the base of the penis. Obesity is the main cause of buried penis.

What is scrotal lymphedema?

Scrotal lymphedema is a buildup of fluid that causes swelling in the soft tissues of the genital area. It’s caused by a blockage or damage to the lymphatic system, which is the system that helps to remove waste and toxins from the body. Often the damage is related to cancer treatments or surgeries.

Procedure Details

How is surgery for buried penis and scrotal lymphedema done?

Surgery for buried penis and scrotal lymphedema is a complicated process. It’s done after other less invasive treatments have been tried. These include weight loss in obese adult males or compression strategies for lymphedema. Depending on the severity, surgery may be done by a team including both a urologist and plastic surgeon.

The surgery is done under general anesthesia and usually requires a hospital stay. In overweight adult males, it may also include a procedure to remove fatty abdominal tissue.

The surgery usually begins with a catheter (thin, flexible tube) being inserted into the urethra to stabilize the penis and protect the urethra (tube that caries urine out of the body). The shaft of the penis is then separated from surrounding tissues (degloved). Infected or scarred tissue is then removed. Surgery can involve:

  • Detaching the ligament that attaches the base of the penis to the pubic bone.
  • Suction lipectomy, or the removal of fat cells using surgical suction catheters inserted through tiny incisions.
  • Panniculectomy, or the removal of the pannus (excess skin and fatty tissue that hangs down over the genitals and/or thighs).
  • Escutheonectomy, or the removal of the fat pad above the pubic area.

Skin grafts are then done, if needed, to cover the penile shaft that has been separated from surrounding tissues. Skin for the graft is usually taken from the patient’s thigh. In patients with buried penis caused by scrotal lymphedema, skin grafts also may be needed. However, there is usually enough uninvolved skin to rebuild the scrotum without grafting.

Risks / Benefits

What are the risks of surgery for buried penis or lymphedema?

Surgery for buried penis and lymphedema is often successful, with little to no reoccurrence of the condition. Most males who have had surgery for buried penis or lymphedema have normal urination and sensation in the genital area after surgery. However, possible complications include:

  • Swelling of the penis.
  • Painful erections.
  • Less sensitivity in the genital area.
  • Poorly healed skin grafts.

If you notice any of these symptoms in your child or yourself, talk to your healthcare provider.

Recovery and Outlook

What happens after surgery for buried penis or scrotal lymphedema?

A course of antibiotics is usually prescribed for a week, sometimes longer. Adults are able to go home three or four days after surgery, but must return for a graft check and catheter removal after a week. Children are typically able to go home following surgery and don’t require the use of antibiotics. Patients are followed up as outpatients within four to six weeks, and they’ll need checkups with a healthcare provider for at least a year.

Last reviewed by a Cleveland Clinic medical professional on 01/22/2021.

References

  • NIH. Accessed 1/25/2021.Buried Penis: Evaluation of Outcomes in Children and Adults, Modification of a Unified Treatment Algorithm, and Review of the Literature (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893803/)
  • Elkiran YM, Elshafei AM, et al. J Vasc Surg Cases Innov Tech. 2019;5(1):71-74. Published 2019 Mar 11. Accessed 1/25/2021.Surgical management of giant scrotal lymphedema in morbidly obese patient with trisomy 21. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416375/)
  • Pestana IA, Greenfield JM, Donatucci CF et al. Management of “buried” penis in adulthood: An overview. _Plast Reconstr Surg. _124(4);1186-1195; 2009.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy