Buried penis: Classification surgical approach

PurposeThe purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction.Materials and MethodsSixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1—29 patients with Longer Inner Prepuce (LIP) only, Grade II—20 patients who presented with LIP associated with indrawn penis that required division of the fundiform and suspensory ligaments, and Grade III—12 patients who had in addition to the above, excess supra-pubic fat.Operative ApproachA ventral midline penile incision extending from the tip of prepuce down to the penoscrotal junction was used in all patients. The operation was tailored according to the BP Grade. All patients underwent circumcision. Mean follow up was 3 years (range 1 to 10).ResultsAll 61 patients had an abnormally long inner prepuce (LIP). Forty-seven patients had a short penile shaft. Early improvement was noted in all cases. Satisfactory results were achieved in all 29 patients in grade I and in 27 patients in grades II and III. Five children (Grades II and III) required further surgery (9%).ConclusionsCongenital buried penis is a spectrum characterized by LIP and may include in addition; short penile shaft, abnormal attachment of fundiform, and suspensory ligaments and excess supra-pubic fat. Congenital Mega Prepuce (CMP) is a variant of Grade I BP, with LIP characterized by intermittent ballooning of the genital area.