Features of a congenital buried penis:
(1) The penis barely protrudes from the body, often with the prepuce forming a cone or cover over the glans.
(2) The finding is present at birth and during childhood. It may persist into adulthood.
(3) The penile shaft length is normal on palpation, but retracted proximally.
(4) There is often a prominent peno-pubic panniculus as well as other foci of fat deposits.
(5) The patient may present with ballooning of the prepuce during micturition (Lennon et al).
Problems:
(1) small amount of penile shaft skin
(2) abnormal bands pulling the corpora proximally (dysgenetic dartos fascia bands extending from Scarpa's fascia of the abdomen onto the distal penile shaft [Alter and Ehrlich, page 458])
(3) inadequate attachment of skin and dartos fascia to Buck's fascia
(4) excessive fat
Circumcision by an unsuspecting clinician can result in a number of significant complications. The problem needs to be treated by a urologist, who must:
(1) release the corpora from connective tissue bands
(2) tack tissue to prevent proximal retraction (peno-scrotal skin to the corpora and to the tunica albuginea)
(3) consider removal of excessive fat
