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He was able to show his distal penile shaft and penis by applying pressure to the surrounding pubic areas with his fingers. His original circumcision was five years ago and he had recently had another circumcision two months ago the submitted tissue from the recent procedure was diagnosed as lichen sclerosus. His cutaneous history had been remarkable for stasis dermatitis of his legs, onychogryphosis and pincer nails of the toenails on both feet, and a basal cell carcinoma on his right proximal nasal bridge near the medial canthus.Ĭutaneous examination of his pubic region demonstrated not only scrotal alopecia, but also that his circumcised penis was buried and only the tip of the glans penis was visible (Figure (Figure2). His past medical history was significant for diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, hypertension, and low grade papillary urothelial bladder carcinoma.
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He did not want to pursue any treatment for his adult acquired buried penis.Īn obese 71-year-old man presented for a total body skin examination. His recurrent fungal intertrigo, a buried penis-related comorbidity, was successfully managed by applying ketoconazole 2% cream twice daily. His actinic keratoses were treated with cryotherapy using liquid nitrogen. The Candida intertrigo affected not only the skin fold beneath the lower abdomen but also the inguinal region and groin. Only the distal tip of his circumcised buried penis was visible (black arrow). The characteristics of adult acquired buried penis-a hidden problem in obese men-are reviewed.Īdult acquired buried penis in a 62-year-old obese man with condition-associated recurrent Candida intertrigoĭistant left (a) and closer frontal (b) views of the genital region of an obese 62-year-old man. One of the men also had biopsy-confirmed penile lichen sclerosus. The features of buried penis in three obese adults are described. There are multiple potential causes of acquired buried penis however, obesity is the most common etiology in adult men. Buried penis can be a congenital condition or an acquired disorder it occurs in children and adults who have either a normal or an elevated body mass index. īuried penis describes a condition in which either skin and/or fat in the prepubic area encompasses a penis of normal size clinically, the penis is not visible or appears short and buried in the prepubic tissue when the patient is examined. There are several obesity-associated medical conditions, such as diabetes mellitus and hypertension in addition, adult acquired buried penis is a comorbid problem that may develop in obese men. Indeed, a large portion of the population is overweight or obese. Obesity is a prevalent health problem of epidemic proportion.
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Most patients are pleased with the functional and aesthetic outcome following surgery.
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The surgical management is individualized and based on not only the extent of the problem but also whether an associated condition, such as urethral stricture, is present. A multidisciplinary approach-including surgeons, primary care physician, registered dietitian nutritionist, and psychiatrist-should be considered for a patient with a buried penis. Both buried penis and lichen sclerosus can predispose to the development of penile squamous cell carcinoma the diagnosis of this tumor can be delayed in men with adult acquired buried penis since an adequate penile examination is difficult or impossible. The evaluation of a man with adult acquired buried penis begins with a detailed history for condition-related symptoms. Examination of the patient, both standing and supine with an attempt to demonstrate the penis using digital compression of the surrounding skin and fat, should be performed to determine the extent of the problem and whether comorbid conditions-such as infection and lichen sclerosus-are present. Lower urinary tract symptoms, such as voiding, and post-voiding problems are the most common presenting complaints however, bacterial and fungal infections, phimosis, psychological issues, and sexual dysfunction, are also buried penis-related symptoms. In addition to morbid obesity, a buried penis can result from other etiologies, such as hidradenitis suppurativa, iatrogenic causes such as elective surgeries, infections, lichen sclerosus, penoscrotal lymphedema, and traumatic events. The clinical characteristics of three obese men with adult acquired buried penis are described and the associated features of the buried penis are reviewed. In adult men, buried penis occurs as an acquired condition most commonly caused by morbid obesity. Buried penis is a condition where the penis is hidden by abdominal or suprapubic skin or fat.