THE INCONSPICUOUS PENIS

ABSTRACT. objective. To describe the etiology and management of the gr oup of abnormalities referred to as the inconspicuous penis. Design. A nalysis of 19 cases seen over a period of 2 years by chart review. Set ting. Children's hospital in a major metropolitan area. Patients. Nine teen boys referred to two pediatric urologists over a period of 2 year s with penises that appeared abnormally small, but on palpation and me asurement, were found to have a normal shaft with a normal stretched l ength. Diagnoses included were buried penis, webbed penis, and trapped penis. Patients ages ranged from 1 week to 13 years. Findings. There were eight patients (42%) with trapped penis, and all were complicatio ns of circumcision (age 1 week to 7 months). Of nine (47%) patients wi th buried penis, two had been circumcised prior to diagnosis. One (5%) patient had webbed penis and one (5%) had combined buried and webbed penis. Intervention. Six trapped penises were surgically repaired, and two resolved spontaneously. Five patients with buried penis had surgi cal repair, and two are being followed up for probable repair at age 9 to 12 months. Two were not repaired because of medical conditions or parental concerns. The webbed penis was surgically repaired as was the combined buried and webbed penis. The repairs were all successful and had no complications. Conclusions. Inconspicuous penis encompasses a group of conditions in which the penis appears small but the shaft can be normal or abnormal in size. Circumcision is contraindicated in the se patients until they have been evaluated by a urologist. Further stu dy is needed to determine the natural history of these disorders and t o better define which patients will benefit from surgical intervention and at what age.