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The inconspicuous penis in children

Key Points

  • An inconspicuous penis can result in considerable concern for both parents and children

  • 9% of patients presenting for initial circumcision have evidence of an inconspicuous penis

  • Micropenis is defined as stretched penile length that is at least 2.5 SD below the mean for the patient's age, without any other abnormalities, such as hypospadias

  • 'True micropenis', caused by deficient secretion and action of testosterone, should be distinguished from 'concealed micropenis'

  • Medical and surgical treatments for inconspicuous penis disorders aim to restore normal penis size, standing micturition and enable future sexual activity

  • Surgical correction of concealed penis is currently the gold-standard treatment

Abstract

The term 'inconspicuous penis' refers to a group of anatomical abnormalities in which the penis looks smaller than is expected. Micropenis can be defined as 'true micropenis'—which results from a defect in the hypothalamic–pituitary–gonadal axis—and 'micropenis secondary to congenital anatomical anomalies of the surrounding and overlying structures'—also known as 'concealed penis'. The different forms of concealed penis include webbed penis, congenital megaprepuce and partially hidden penis caused by prepubic adiposity. This disorder can also have iatrogenic causes resulting from adhesions that are secondary to circumcision—this type of concealed penis is known as 'trapped penis'. However, in both groups, micropenis is defined as a stretched penile length that is at least 2.5 SD below the mean for the patient's age, but without any other penile defects. Patients with true micropenis can be managed with testosterone, which has demonstrated good penile elongation results in the long term. Surgery also has a pivotal role in reconstruction for elongating the penis and for correction of anatomical abnormalities in concealed penis.

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Figure 1
Figure 2: Surgical correction of buried penis with congenital megaprepuce.
Figure 3

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P.C. and R.O. researched data for the article. M.C.and M.G. made a substantial contribution todiscussion of content. All authors contributed to writing the article. M.C. reviewed and edited thearticle before submission.

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Cimador, M., Catalano, P., Ortolano, R. et al. The inconspicuous penis in children. Nat Rev Urol 12, 205–215 (2015). https://doi.org/10.1038/nrurol.2015.49

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