Among these conditions, the most common are partial and complete amputation of the penis caused by trauma or when penile tissue has been removed to treat a cancer of the penis. Penile reconstruction might be necessary in patients when the size of the penis is inadequate to engage in penetrative sexual intercourse.

When sexual and urinary functions are compromised in patients with buried penis or lichen sclerosus of the penis, penile reconstruction can yield excellent cosmetic and functional results.

Lichen Sclerosus

Lichen sclerosus is a disease of the skin of the genitals. In the male it can affect the foreskin, the glans and in the most severe cases all the skin of the penis and the inside lining of the urethra (= the waterpipe). The causes responsible of lichen sclerosus are still not well understood but it is now believed that maceration of the skin caused by pooling of urine, recurrent skin infections, and the presence of predisposing factors such as diabetes and low testosterone levels might be linked to the formation of lichen sclerosus.

Treatment of lichen sclerosus is necessary not only to improve sexual and urinary functions in these patients, but also because if left untreated, lichen sclerosus can degenerate into cancer of the penis.

Buried Penis

Buried penis indicates the clinical situation when the penis is hidden in the prepubic fat. A buried penis is usually present in patients with excessive fat in the pubic area (=lower abdomen) or when excessive skin has been removed during circumcision or when the two situations coexist.

Buried penis frequently requires the combined intervention of a bariatric surgeon and of the uro-andrologist.
Significantly overweight patients need to loose weight first and in this case the intervention of the bariatric surgeon can be extremely useful.

Frequently Asked Questions

There are various clinical conditions in genetic male patients where penile reconstruction may be required. Among these conditions, the most common are penile tissue loss due to trauma, surgery or excision of benign or malignant conditions of the penis.

When sexual and urinary functions are compromised in patients with buried penis or lichen sclerosus of the penis, penile reconstruction can yield excellent cosmetic and functional results and allow them to resume sexual and urinary function with confidence.

Lichen sclerosus is a disease of the skin of the genitals. In the male it can affect the foreskin, the glans and in the most severe cases all the skin of the penis and the inside lining of the urethra (= the waterpipe). The causes responsible of lichen sclerosus are still not fully understood but it is now believed that maceration of the skin caused by pooling of urine, recurrent skin infections, and the presence of predisposing factors such as diabetes and low testosterone levels might be linked to the formation of lichen sclerosus. 

Typically, the skin affected by lichen sclerosus becomes thicker, inelastic and tends to become white. As the skin is not elastic, it cracks during sexual activity and this may cause pain, itching and bleeding. When affected by lichen sclerosus, the foreskin becomes unretractable in a clinical picture also known as phimosis. 

As it becomes impossible to retract the foreskin to clean the corona and the glans (=the head of the penis), hygiene becomes poor and patients may suffer from recurrent urinary tract (=the waterwork) infections. If the lichen sclerosus affects the urethra, this can cause narrowing of the urethral tube and urination can become challenging.
Lichen sclerosus always originates at the level of the glans and the foreskin and then propagates towards the base of the penis and/or the urethra.

Treatment of lichen sclerosus is necessary not only to improve sexual and urinary functions in these patients, but also because if left untreated, lichen sclerosus can degenerate into cancer of the penis. 

In the early stages of lichen sclerosus, local application of steroid creams can lead to improvement of the symptoms. However, patients need to be aware that lichen sclerosus always recurs when the applications are stopped.

When there is no response to application of topical steroids or in the more aggressive forms of the disease, treatment of lichen sclerosus involves excising all the affected skin, which is sent to the laboratory for analysis.

In fact, lichen sclerosus and cancer of the penis coexist in up to 10% cases.

When lichen sclerosus is more diffused, the penis needs to be reconstructed with the use of skin grafts. This procedure, in experienced hands, leads to excellent results, with satisfactory restoration of sexual and urinary function. 

Buried penis indicates the clinical situation when the penis is hidden in the prepubic fat. A buried penis is usually present in patients with excessive fat in the pubic area (=lower abdomen) or when excessive skin has been removed during circumcision or when the two situations coexist. 

In patients with buried penis sexual and urinary function are severely compromised.

Quality of life tends to be poor as the patient is not able to expose the penis while urinating and therefore the pooling of urine in the abdominal skinfolds causes maceration of the skin and recurrent urinary infections, which can ultimately lead to renal damage. As the skin is macerated by the urine and is always moist, the formation of lichen sclerosus is quite common and this makes the situation worse.

Buried penis frequently requires the combined intervention of a bariatric surgeon and of the uro-andrologist. 

Significantly overweight patients need to loose weight first and in this case the intervention of the bariatric surgeon can be extremely useful.

Once patients have reached the target weight, the management of the buried penis requires the excision of the suprapubic fat and of all the excess skin performing an abdominoplasty. 

If there is not enough penile skin, or if the skin needs to be removed because it is affected by lichen sclerosus, the penis needs to be reconstructed using a variety of skin grafts. In expert hands, abdominoplasty, excision of the suprapubic fat and penile reconstruction, yield excellent functional and cosmetic results and allow patients to restore sexual and urinary function.

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What to expect

Free Consultation with one of our Patient Advisors

We offer a free, no-obligation 30-60 minute consultation with one of our Patient Advisors. They will work with you to understand your objectives and the results you want to achieve, talk you through the procedure and answer any questions you may have. If you decide that you would like to proceed to the next step and see a surgeon, your Patient Advisor will be happy to arrange this for you. At this point, you will be required to pay a consultation fee. 

Surgical Consultation

The next step is for you to meet your chosen surgeon at the Cadogan Clinic. Your surgeon will use this time to make a comprehensive medical assessment of you, your condition, and your expectations before making a recommendation and personalised treatment plan for you. You will then discuss the outcomes you can expect to see and ask any questions.

The Procedure

On the day of your procedure you will be welcomed at the Cadogan Clinic by your Patient Advisor and dedicated nursing staff. Following a brief medical check, you will meet with both your surgeon and anaesthetist to run through the details of your procedure one final time and answer any last questions you may have.  

Recovery

After the procedure, you will recover in the capable hands of our aftercare team. As we are a day-case facility you can expect your recovery to be complete within 2 to 3 hours. If your surgeon is happy with your results, you will be able to be discharged from the Clinic the very same day. In some cases patients may wish to stay locally in our exclusive partner hotel the day before or after your procedure in order to be close to their surgeon. Talk to us about these options if this is for you. 

After Care & Support

Our care and support continues in the days and weeks following your procedure with our complimentary aftercare programme. This comprised of a series of appointments made with your surgeon and nursing team to monitor your progress and recovery. They will also introduce you to several scar minimization techniques and bespoke products to aid your progress. Our team are also on call to answer any questions you have around your surgery at any time you are concerned.

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We only work with the best. Our consultants are at the very peak of their professions. All are registered with the General Medical Council (GMC) and their own specialist registers, so you can feel confident you’re in safe and trusted hands.
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Mr. Giulio Garaffa
Mr. Giulio Garaffa

Uro-Andrologist

Considered one of the world leading experts in his fields of interest and is invited world wide to give lectures and perform live surgery