It is the preputial narrowness that makes it impossible to expose the head of the penis (glans). It requires treatment when it has not resolved spontaneously after 3-4 years of age. Massage of the foreskin should be avoided, as it can develop scarring at the tip of the foreskin and develop scarred phimosis. May need circumcision before 3 years in case of urinary infection (in less than 1 year), repeated Balanitis, paraphimosis, preputial bladder, or that the infant presents other urological malformations. Surgery is performed after 3-4 years, especially if you do not respond to topical corticosteroids.
In the case of hidden penis, the surgery not only involves the skin on the tip of the penis, but also involves mobilizing the skin of the penis, scrotum and pubis. This technique allows to expose the shaft of the penis that is hidden by poor skin implantation. Note that this patient was previously circumcised, but kept a large part of the shaft of the penis hidden under the skin of the pubis. The surgery consists of repositioning the skin at the base of the shaft of the penis, reducing pubic fat, and wrapping flaps of skin around the shaft of the penis and separating the scrotum from the penis. Generally, the skin does not cover the glans (head of the penis), which is exposed as in the photo. It can be complemented with liposuction of pubic fat if necessary.