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Hidden penis
Last reviewed: 04.07.2025
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Another unsolved problem in pediatric urology is the so-called hidden penis. This problem is more likely to be dominated by the social aspect than by the functional issue.
Adult patients with a hidden penis have a cosmetic defect, but at the same time, neither the act of urination nor their sexual life are usually impaired, except in cases where this anomaly is combined with phimosis.
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Today, there is no single point of view on the classification of this pathology, since some urologists generally consider this pathology to be a variant of penis development and, accordingly, do not perform any surgical intervention. From the point of view of most urologists, a hidden penis is a developmental defect of the male genitalia, requiring surgical correction in the overwhelming majority of cases.
Most clinics have developed and implemented a classification of this pathology.
A truly hidden penis is characterized by a marked deficiency of the skin of the phallus itself, a distally located suspensory ligament of the phallus, and a short sling-like ligament.
A "trapped" penis, in which there is some deficiency of the outer skin of the penis in combination with stenosis of the foreskin, which, in fact, leads to the situation of a recessed phallus.
Secondary hidden penis - as a manifestation of general obesity, in which the fatty tissue of the pubic area displaces the skin and looks like corrugated tissue, and at the moment of erection the phallus straightens almost completely.
A combined defect in which a combination of the three options described above is possible.
Combined variant of developmental defect with hypospadias, epispadias, cryptorchidism, inguinal hernia, etc.
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Treatment of a hidden penis
In the vast majority of cases, surgical intervention for the third form of the defect is not indicated. Only in exceptional situations - at the urgent request of the patient for the purpose of optimal adaptation in society - should surgery be performed.
The surgical intervention begins with a border incision around the head of the penis, after which the skin is completely mobilized to the penosyphysial angle and the ligament suspending the phallus (lig. suspensorium penis) and the sling-like ligament are cut. Then, at 9 and 3 o'clock on the conventional clock face, two interrupted sutures are applied from the inside between the protein membrane of the brought out cavernous bodies and the skin of the penis at the border of the transition of the actual skin of the shaft into the scrotum. For this purpose, monofilament non-absorbable suture material is used. The inner leaf of the foreskin is split and the mobilized cavernous bodies are covered with the actual skin.
The second form of hidden penis is treated by removing the scar of the foreskin, which prevents the head and the entire shaft from coming out.
The most problematic is the hidden penis of the first variant. The true deficiency of the skin of the trunk in some cases does not allow to solve the problem overnight. Sometimes surgeons are forced to resort to the use of hormonal therapy in order to increase the supply of plastic material. For this purpose, dihydrotestosterone gel is used in the form of applications, which allows in a short period (3-4 weeks) to build up a sufficient amount of skin fold for phallus plastic surgery.
After several weeks of using hormonal applications, the operation described above is performed.
In the postoperative period, urine is drained using a urethral catheter for 5-7 days. A compression bandage is also used, its wearing is recommended for up to 6 months, since in this case it plays a fixing role. In adult patients, special penile extensor devices are used for this purpose, applied 4 hours a day for 6 months.