الفهرس 
ANATOMYOnly 14 pages are availabe for public view
 |  | from | 93 |  |  |
| | | from | 93 | | |
Abstract
Inconspicuous penis is a term used in referring to a phallus that is or only appears to be small. Seven urologic entities that fall under this term have been described. These conditions are poor penile suspension, buried penis, webbed penis, trapped penis, concealed penis, diminutive penis and micropenis. Proper treatment is dependent on accurately diagnosing which entity is present
The buried penis was initially described by Keves in 1919. It consists of a penile shaft that is otherwise normal but buried within an overabundance of prepubic fat. Abnormal dysgenic dartos bands coursing between Scarpa’s fascia and located primarily on the dorsal surface of the shaft of the penis, binding the penis in varying degrees, have also been described. This term has sometimes been confused with “concealed penis,” an acquired condition associated with thick suprapubic subcutaneous fat pad in an obese boy. Surgical correction of concealed penis in association with obesity is unnecessary, because the condition is self correcting
Trapped penis is an acquired form of inconspicuous penis; the term refers to a phallus that has become embedded in the suprapubic fat pad after circumcision. While the condition of the webbed penis has been postulated that a disturbance in development of the prepuce may leave the ventral penis with inadequate skin coverage, resulting in the borrowing of scrotal tissue
A penis may be small and malformed as a result of epispadias/exstrophy, severe hypospadias, persistent mullerian structures, or chromosomal abnormalities. These individual entities are well described in the literature. This category is sometimes referred to as the diminutive penis and is distinguishable from micropenis since the micropenis is small but not malformed
When an infant has an inconspicuous penis, prompt evaluation is necessary for proper treatment and also for determining the best timing for intervention.
It is important, however, for pediatricians to be aware of this group of disorders because circumcision is certainly contraindicated using standard techniques. Repair of the complications that may result is significantly more costly and presents additional surgical risks.
An abnormal appearance of the external genitalia may have psychological effects on the child and his family surgical correction of this condition is indicated, not only for cosmetic reasons, but also for urinary retention, urinary tract infection, and difficult voiding caused by associated phimosis. In adult patients, it may affect vaginal penetration, cause painful erection, or difficulty in urination
The optimum age for repair of a buried penis is a subject of some discussion; this is because of many aspects regarding the recurrence rate in different age groups and the psychological impact on both the patient and parents. On the other hand some pediatric urologists insist that this condition is a developmental stage that will resolve at puberty; although there is evidence that spontaneous resolution does not always occur.
It has been universally accepted that the release of abnormal dartos attachments and fixation of the penile skin to Buck’s fascia are the key steps to correction. These surgical steps are the key procedures applied to all subtypes of inconspicuous penis. Additional steps are used as necessary, depending on each subtype.