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Genital Reconstructive Surgery

Before anything else

Most people who come to us for these conditions have been living with them for years.

Not because they weren't treatable — because they were embarrassing. Because it was hard to bring up with a primary doctor. Because a previous visit went badly. Because it felt like something to hide rather than something to fix.

We want to say this plainly: these are common surgical problems with good surgical solutions, we see them regularly, and nobody in this office is going to react to your anatomy. Whatever has been going on, and for however long, you can describe it here.

What this covers

Genital reconstructive surgery — sometimes called genitoplastics — restores the function and appearance of the external genitalia when disease, injury, weight change, infection, or previous surgery has damaged them.

The two conditions we're asked about most are adult acquired buried penis and hidradenitis suppurativa affecting the groin, scrotum, and perineum. We also treat genital lymphedema, reconstruction after Fournier's gangrene, scrotal reconstruction, skin loss after infection or injury, complications of circumcision, and skin conditions such as lichen sclerosus.

Adult Acquired Buried Penis

What it is

A buried penis is a penis of normal size that has become trapped and hidden beneath the skin and fat of the lower abdomen, scrotum, or thigh. The organ itself is usually completely normal. It simply cannot get out.

This is a mechanical and skin problem, not a size problem — an important distinction, because the repair is about releasing and resurfacing, not enlarging.

How it develops

  • Weight gain, which enlarges the fat pad above the pubic bone until it engulfs the shaft. This is the most common cause.

  • Significant weight loss, which can leave a hanging apron of skin that does the same thing.

  • Lichen sclerosus, a chronic inflammatory skin condition that turns genital skin white, tight, and inelastic, tethering the penis inward. It can also narrow the urethra.

  • Previous circumcision or genital surgery that left too little shaft skin or a constricting scar ring.

  • Lymphedema, where chronic swelling thickens the tissue.

  • Chronic infection and skin breakdown, which scars the skin down.

Often several of these are present at once, each making the others worse.

Why it's worth fixing

Buried penis is not a cosmetic complaint. It causes real medical problems:

  • Urine cannot exit cleanly. It sprays, soaks the surrounding skin, and pools in the skin folds.

  • That constant moisture causes chronic skin inflammation, yeast infection, and recurrent cellulitis, sometimes requiring hospitalization.

  • Hygiene becomes impossible, which drives more infection.

  • Many men end up urinating sitting down because there is no other way to control the stream.

  • Sex becomes difficult or impossible.

  • Over years, the trapped skin can develop chronic inflammation and, rarely, skin cancer.

And there is a cycle worth naming directly: the condition makes it hard to be active, being inactive makes weight harder to lose, and weight makes the condition worse. Men are frequently told to lose weight first and come back. Sometimes that's right. Often it isn't achievable until the surgery is done, and we take that seriously rather than sending you away.

How we evaluate it

  • Examination of how much healthy shaft skin exists, how much fat is involved, and whether the scrotum is contributing

  • Assessment for lichen sclerosus, which changes the operation — diseased skin cannot be reused and must be replaced

  • Checking the urethra, since lichen sclerosus and chronic inflammation frequently cause a stricture as well, and that needs to be addressed in the same plan

  • A conversation about weight, honestly and without lecturing, including whether bariatric surgery or medication belongs in the plan and whether it comes before or after

The repair

Every buried penis repair is individualized, but it is generally built from some combination of:

  • Escutcheonectomy — removing the fat pad and excess skin directly above the penis, which is often the single most effective part of the operation

  • Panniculectomy — removing a larger overhanging abdominal apron when that's what's causing the burial

  • Release of the scar tissue and constricting rings tethering the shaft

  • Scrotoplasty — reshaping the scrotum when it has ridden up and swallowed the shaft

  • Split-thickness skin grafting to resurface the shaft when the original skin is destroyed by lichen sclerosus or chronic infection and cannot be salvaged. The graft is usually taken from the thigh.

  • Urethral repair, if a stricture is present

Depending on complexity, this may be done in one operation or staged.

Recovery

This is a bigger recovery than most people expect, and being prepared for it makes it much easier.

  • Usually one to several nights in the hospital

  • Surgical drains for a period afterward, which we'll teach you to manage

  • A catheter for a period of time

  • If a skin graft was used, the graft must be kept immobile while it takes — often with a bolster dressing and restricted activity for the first week or two

  • Significant swelling and bruising, which looks alarming and settles over several weeks

  • Several weeks off work for most people, longer for physical jobs

  • Wound problems are relatively common in this operation, particularly in patients with diabetes or a high BMI, and may require additional dressing changes or minor revisions

Results

Satisfaction after buried penis repair is high. The outcomes patients report as most meaningful are usually not what surgeons expect: being able to urinate standing up, being able to keep clean, no longer getting recurrent infections, and being willing to be seen.

Weight regain can cause the burial to recur, which is why the weight conversation is part of the plan rather than an afterthought.

Hidradenitis Suppurativa of the Groin, Scrotum, and Perineum

What it is

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects areas where skin rubs against skin — the groin, genitals, buttocks, perineum, armpits, and under the breasts.

It causes painful deep nodules, abscesses that drain and recur in the same spots, tunnels beneath the skin called sinus tracts, and dense scarring over time. It is not caused by poor hygiene and it is not contagious or sexually transmitted. It is an immune-mediated disease of the hair follicle.

Many people have been treated for years with repeated courses of antibiotics and repeated incision and drainage of abscesses without anyone naming the underlying condition.

Why a urologist

When HS involves the scrotum, penis, perineum, or the area around the anus, it stops being purely a skin problem. Advanced disease in this region can:

  • Destroy scrotal skin

  • Create tunnels that connect to the urethra or the skin around the anus

  • Cause chronic drainage that makes hygiene and sexual function impossible

  • Involve tissue that requires reconstructive expertise to close once excised

Reconstructing that anatomy is what we do.

Treatment is a team effort

HS is managed medically by dermatology — with topical and oral therapies, and biologic medications that have substantially changed outcomes for moderate to severe disease. Medical therapy controls inflammation and slows new disease.

Surgery removes what medicine cannot reverse. Once sinus tracts and scarring are established, no medication will make them disappear. The two approaches are complementary, not competing, and the best results come from doing both. If you don't currently have a dermatologist managing this, we'll help you get one.

Surgical treatment

Wide local excision

The established operation for severe localized disease is to remove all the affected skin and the tissue beneath it, down to healthy tissue, with margins beyond the visible disease.

This is the critical point: incomplete excision leads to recurrence at the edges. Limited operations that only drain abscesses or remove obvious tracts tend to fail. Definitive surgery means taking more than looks necessary, which is why the resulting wound is larger than patients anticipate.

Reconstruction

How the wound is closed depends on its size and location:

  • Healing by secondary intention — leaving the wound to close on its own with dressing changes, often with negative-pressure wound therapy to speed it. Slower, but durable, and it works well in the groin.

  • Split-thickness skin grafting for large surface defects, including scrotal resurfacing.

  • Local flaps, moving nearby healthy tissue in to cover the defect.

  • Scrotal reconstruction, including creating a new scrotal pouch. The testicles themselves are almost always preserved — they are rarely involved by the disease even when the overlying skin is destroyed.

Recovery

Recovery is longer than for most urologic operations, and honesty about this matters more than optimism. Depending on the extent, wound care may continue for weeks to a few months. We will set up the wound care support you need rather than sending you home to figure it out.

What patients consistently report afterward is relief: the end of constant pain, constant drainage, and constant dressing changes.

Common questions

Will insurance cover this? These are functional, medically indicated operations, not cosmetic ones, and they are generally covered. Documentation of infections, hygiene problems, and failed conservative treatment strengthens the case, and our office handles that process.

Do I have to lose weight before you'll operate? Sometimes weight loss meaningfully improves the result and is worth doing first. Sometimes it isn't realistically achievable until after surgery. We'll give you an honest answer for your situation rather than a blanket rule.

Will I be able to urinate standing up again? For most men after buried penis repair, yes. It's one of the most commonly reported improvements.

Will my HS come back? Not usually in an area that has been completely excised. It can appear in new areas, which is why ongoing dermatologic treatment matters after surgery.

Will it look normal? The goal is normal function and a normal-appearing result. Reconstructed skin — particularly grafted skin — can differ somewhat in color and texture. We'll show you what to expect beforehand.

I've been putting this off for years. Is it too late? Almost certainly not. Long-standing, severe disease is what this field exists to treat.

Questions worth asking at your consultation

  • What exactly is causing the problem in my case?

  • Will this be one operation or staged?

  • Will I need a skin graft, and where from?

  • What is the realistic recovery time, and what will wound care involve?

  • What are the chances this recurs?

  • Do I need a dermatologist or a weight-management referral as part of the plan?

To schedule a consultation and discuss which option is right for you, please visit our CONTACT page.