Hidden Penis

Hidden penis is not an uncommon etiology. It is due to the suprapubic fat pad as well as poor anchoring at the penopubic and the penoscrotal junction. This four quadrant anchoring is what allows the penis to be extruded. In adults, hidden penis surgery is also known as penile elongation surgery. The surgical principles in adults are the same as in children, which is four quadrant anchoring at the base of the penis.

While in adults elongation penis are mostly done as a cosmetic procedure, in children it is done due to clinical issues. In infants it usually presents as a penis that is rarely seen even with erections. The majority of the time it also presents with the foreskin getting stuck the head of the penis and looks like an incomplete circumcision. This can also present with bleeding and pain when parents try to pull the skin back to clean the penis. In infants or children who are not circumcised, the penis will appear short and have a “volcano” appearance. In older children it can present as a “belly button” appearance of the penis and many time the child complains of having no penile shaft to hold. Many times it is associated with a suprapubic fat pad which can exacerbate the appearance. Treatment typically involves a combination of weight loss and surgery. In infants, usually surgery alone will correct the hidden penis.

Hidden penis has to be differentiated from micro penis, which is a distinct entity. Micro penis is rare and is diagnosed if the penis is 2.5 standard deviation below the normal. If hidden penis is suspected at birth, circumcision should not be performed as the foreskin is needed for skin coverage during surgical repair.