The “buried penis” is a rare condition, but its incidence is expected to increase due to rising risk factors such as obesity and diabetes. Currently, addressing this issue poses a significant challenge for reconstructive surgery, as there is no standard treatment applicable to all patients. Several surgical techniques exist, which can be combined, aiming to restore both the functionality and aesthetics of the penis. The decision on which method to use varies based on the severity of the condition, the origin of the problem, the patient’s health status, and their personal preferences.

The available techniques include:

• Abdominoplasty
• Panniculectomy: removal of the abdominal panniculus that may hang over the penis
• Escutcheonectomy: removal of the suprapubic adipose tissue, commonly known as the mons pubis, located above the penis, beneath the abdominal panniculus
• Scrotoplasty

The choice of surgical approach also depends on the condition of the skin covering the shaft of the penis. In rare cases, the skin may appear healthy, as in cases of particularly invasive circumcisions, and could potentially be preserved. However, most of the time the skin is inadequate to fully cover the penile shaft due to being diseased or insufficient. In these situations, it is possible to remove the damaged tissue and replace it with a graft, generally taken from the thigh or abdomen. In some cases, flaps from the scrotum can also be used. Such procedures are usually performed under spinal anesthesia and take several hours.

In conclusion, managing a buried penis can be complex, and treatment options vary significantly. A personalized approach, considering the etiology and extent of tissue involvement, can lead to a significant improvement in sexual and urinary function, as well as an enhancement in the patient’s psycho-physical well-being. For this reason, it is advisable to consult an expert specialized in this area.

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