Diagnosis and treatment of concealed penis and phimosis

**Concealed Penis**

A concealed penis refers to a penis that is hidden under the skin.

**Western Medical Etiology and Pathology**

During embryonic development, the distal end of the urogenital sinus, which normally extends to the genital tubercle, is underdeveloped, leading to...

The penis is hidden under the skin.

**Traditional Chinese Medicine Etiology and Pathogenesis**

The development of the penis is governed by the kidneys and the Tian Gui (a concept in Traditional Chinese Medicine). The kidneys are the foundation of innate essence, storing essence and governing reproduction. If one is born with...

If the endowment is insufficient and the Tian Gui (menstrual blood) is not abundant, then the body cannot be formed, hence the penis is hidden and underdeveloped.

**Key Points of Western Medicine Diagnosis**

(1) There may be a family history, which is more common in obese people.

(2) Often experiences urination difficulties, or even urinary incontinence; the urine stream is not forward and often splashes onto the feet; this does not continue into adulthood.

Capable of sexual intercourse.

(3) The subcutaneous fat around the penis is thickened, and the underdeveloped penis is hidden under the skin; the penis is underdeveloped.

Good, and curved; when the suprapubic bladder is overfilled, a local bulge can be seen.

**Western Medicine Diagnostic Criteria and Differential Diagnosis**

**(I) Diagnostic Criteria**

Phimosis, thickened subcutaneous fat around the penis, underdeveloped penile skin, and abnormal corpora cavernosa and urethral sponge.

Underdeveloped penis. The penis shaft cannot penetrate the penile skin and foreskin cavity; the penis is buried under the foreskin and pubic bone.

Within the subcutaneous adipose tissue.

**(II) Differential Diagnosis**

(1) Congenital absence of the penis: The penis cannot be visually seen from the external genitalia, and is also present in the subcutaneous tissue of the scrotum and pubic region.

The penis cannot be palpated and may be accompanied by other serious congenital malformations, such as anal malformation.

(2) Female: No penis was observed during examination, but the clitoris, labia, and vagina were visible in the external genitalia. The chromosomes were...

46,XX.

**Western Medicine Treatment**

**(I) General Treatment**

(1) Control your diet and increase exercise to reduce obesity.

(2) Push the scrotum backward to allow the glans penis to enter the foreskin cavity, thereby lengthening the penile skin and foreskin cavity.

Several times a day, over a long period of time, some patients may see results.

**(II) Drug Treatment**

(1) Male hormones: methyltestosterone, or testosterone propionate, or testosterone undecanoate. For penile development...

For men with poor penile development, circumcision can be performed in conjunction with the administration of male hormones to promote penile growth.

(2) Human chorionic gonadotropin (hCG) is generally used after the age of 12 to 14.

**(III) Surgical Treatment**

(1) Circumcision: An incision is made in the foreskin opening of the penis. This is suitable for penises with good development and well-developed foreskin.

In individuals with underdeveloped foreskin and phimosis, the glans penis is exposed outside the foreskin opening.

(2) Longitudinal circumcision: Separate the adhesions between the foreskin and the glans penis, retract the foreskin, and make a circumcision approximately [length missing] at the constricting ring.

A longitudinal incision of 1–1.5 cm is made, followed by transverse suturing and freeing, allowing the two triangular flaps to be interchanged and sutured into a Z-shape.

shape.

(3) Z-plasty of the penis: A longitudinal incision of about 3cm is made on the ventral side of the penis, and incisions are made on both sides.

A 2.5cm long incision at a 60° angle (resembling an "N") was made, and the skin was separated from the subcutaneous tissue and freed to create two triangular skin flaps.

The sutures were then transposed and sutured into a Z-shape.

(4) Transverse incision and longitudinal suturing of the foreskin: A transverse incision is made in the skin of the penis and scrotum, along the subcutaneous tissue.

Dissect around the penis, with the incision length and extent sufficient to allow for penile straightening. After hemostasis, remove the transverse incision.

For skin wounds, perform longitudinal interrupted sutures.

(5) Penile reconstruction surgery: Plastic surgery is performed according to the actual shape of the penis.

**Phimosis (excess foreskin)**

Phimosis refers to a condition where the glans penis is completely covered by the foreskin, but the foreskin opening is not narrow and can be retracted to expose the urethra.

Diseases of the vaginal opening and glans penis.

**Etiology and Pathology**

Congenital abnormal development of the foreskin, resulting in excessive foreskin thickness and longness, causing phimosis (tight foreskin) and preventing exposure of the penis.

Stem tip.

**Key Points of Western Medicine Diagnosis**

(1) The foreskin covers the glans penis and can be retracted to expose the urethral opening and the glans penis.

(2) It is easy to develop balanitis, which can cause foreskin edema and pain.

(3) If the foreskin opening is too small, and it is not returned to its original position after being forcibly retracted, the foreskin will be tightly constricted at the coronal sulcus and cannot be retracted.

If paraphimosis occurs, symptoms such as foreskin edema and pain may appear, followed by erosion, ulceration, and necrosis of the glans penis.

**Western Medicine Diagnostic Criteria and Differential Diagnosis**

**(I) Diagnostic Criteria**

The penis was observed to be of normal size, but the glans was concealed within the foreskin opening and could not be exposed; however, the foreskin was able to...

A diagnosis can be made if the penis is turned upwards to expose the urethral opening and the glans penis.

**(II) Differential Diagnosis**

(1) Phimosis: The foreskin cannot be retracted, the glans penis cannot be exposed, urination is slow, the urine stream is thin, and penile erection is difficult.

There are occasional feelings of discomfort, or even pain.

(2) Concealed penis: The penis is underdeveloped and buried in the subcutaneous fat around the penis.

**Western Medicine Treatment**

**(I) General Treatment**

Regularly retract the foreskin and wash it, clean the coronal sulcus, remove smegma, and keep the external genitalia clean and hygienic.

**(II) Drug Treatment**

Generally, phimosis does not require medication; it is only considered when balanitis occurs.

antibiotic.

**(III) Surgical Treatment**

Generally, if the foreskin can be retracted on its own, surgery is not necessary. However, if there are frequent inflammatory reactions or problems during sexual intercourse, surgery may be required.

If discomfort is experienced, circumcision can be performed. However, some experts advocate that phimosis should be surgically corrected as early as possible.

For example, the Department of Urology at Zhongnan Hospital of Wuhan University (formerly the Second Affiliated Hospital of Hubei Medical University) treats cases of phimosis.

The survey found a high incidence of balanitis, smegma, and human papillomavirus (HPV) infection.

Three factors work synergistically within the foreskin cavity, easily leading to penile cancer, while circumcision can simultaneously eliminate these factors.

Carcinogenic factors and prevention of penile cancer.