Uncovering the Hidden Penis: A Nomenclature and Classification System

Area of Science:

• Urology
• Andrology
• Surgical Classification

Background:

• Hidden penis, encompassing "buried" and "trapped" penis, presents challenges in hygiene, voiding, sexual function, and causes patient embarrassment.
• Current classification systems inadequately characterize the spectrum of hidden penis conditions.

Purpose of the Study:

• To propose a simplified nomenclature and classification system for adult-acquired hidden penis.
• To differentiate between "buried" and "trapped" penis presentations and management strategies.

Main Methods:

• Retrospective review of adult patients surgically treated for hidden penis from 2009-2019.
• Classification into "buried" (concealed by suprapubic fat) or "trapped" (fibrous tethering) categories.
• Surgical management included panniculectomy, monsplasty, lysis, phalloplasty, and skin resurfacing.

Main Results:

• Thirteen patients (mean age 53 years, mean BMI 37.4 kg/m2) were analyzed.
• Six "buried" penises (erection issues common) and nine "trapped" penises (voiding difficulties common) were identified.
• Trapped penises were associated with significantly larger body mass index (39.8 vs 34.2 kg/m2). Wound complications occurred in one-third of patients.

Conclusions:

• "Trapped" and "buried" penises exhibit distinct preoperative symptoms and body types.
• The proposed classification system provides a clear management algorithm for hidden penis.
• Further large-scale studies are needed to compare clinical outcomes between "trapped" and "buried" penis types.