Circumcision in 'buried penis' – a cautionary tale

BACKGROUND: The aim of a circumcision is to remove sufficient foreskin from the penile shaft and preputial epithelium to uncover the glans. Removal of too much preputial skin may lead to an unsatisfactory cosmetic and functional result. Patients with a congenital anomaly known as 'buried penis' are particularly susceptible to this. In this condition, abnormal dartos fascial bands or muscle fibres tether the penile shaft and as a result conceal its true length. CASE REPORT: A 5-year-old boy underwent circumcision but his 'buried penis' was not recognised by the surgeon pre-operatively. Unfortunately, his penile shaft was left almost entirely denuded of skin as a result. The wound required a full thickness graft. Follow-up at 1 year has so far been satisfactory. CONCLUSIONS: This case highlights the importance of early recognition of a buried penis when considering circumcision. It demonstrates the abnormal anatomy of a buried penis and its management. It also provides a potential reconstructive option in cases of excess skin removal.