How to cite: Terlecki RP. Search for the Sunken Phallus: Pearls for Excavation. Grand Rounds in Urology. October 2025. Accessed January 2026. https://grandroundsinurology.com/search-for-the-sunken-phallus-pearls-for-excavation/
Summary
Ryan P. Terlecki, MD, FACS, Professor and Vice Chair of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, provides a practical, experience-driven review of buried penis in adults, also known as sunken phallus, focusing on evaluation, surgical planning, operative techniques, and postoperative management. Dr. Terlecki emphasizes that while many providers refer these cases, they can be managed effectively with careful preparation and realistic expectations.
The discussion begins with common etiologies, noting that most cases are associated with obesity and related comorbidities, though scrotal pathology, lymphedema, hidradenitis, and foreign body reactions from penile enhancement injections may produce similar presentations. Dr. Terlecki highlights the importance of avoiding redo circumcision, clarifying that the problem is typically not redundant foreskin but cicatrix formation that traps the penis beneath diseased tissue.
Clinical anatomy and pathophysiology are reviewed using practical analogies to help explain the condition to patients, including the concept of a constricting sleeve that prevents normal skin mobility. Common scenarios include a prominent suprapubic fat pad, inflammatory skin changes, and possible meatal involvement due to lichen sclerosus.
Preoperative planning is emphasized as critical to success. Optimization strategies include addressing obesity, controlling diabetes, managing anticoagulation, assessing pulmonary and hepatic risks, and planning postoperative wound care. Dr. Terlecki discusses the importance of setting expectations, acknowledging high complication risk, and preparing contingency plans for staged reconstruction when needed.
The operative portion of the talk details key technical considerations, including cicatrix excision, monsplasty, protection of spermatic cords, urethral assessment, and judicious use of skin grafting. Options for graft source, thickness, and fixation are reviewed, along with strategies to minimize lymphatic disruption and bleeding. Temporary solutions such as scrotalization are presented as viable bridge approaches in select cases.
Postoperative care pathways are outlined, including the use of vacuum-assisted closure devices, catheter management, dressing strategies, and coordinated follow-up with plastic surgery and wound care teams. Dr. Terlecki emphasizes thoughtful planning, multidisciplinary collaboration, and prioritizing function while still considering cosmetic outcomes.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
ABOUT THE AUTHOR
Ryan P. Terlecki, MD, FACS, is a reconstructive urologist for Atrium Health Wake Forest Baptist Medical Center, an academic Level 1 trauma center in Winston-Salem, North Carolina. Dr. Terlecki holds the rank of Professor and the title of Vice Chair of Research for the Department of Urology. In addition, Dr. Terlecki is Director of the Men’s Health Clinic, Director of Medical Student Education, and Fellowship Director for Reconstructive Urology. He holds a joint appointment in the Department of Obstetrics and Gynecology.
Dr. Terlecki earned his medical degree from Wayne State University School of Medicine and completed residency in general surgery and urology at Detroit Medical Center. Following his residency, Dr. Terlecki completed two separate fellowships in reconstructive surgery. He completed a fellowship at the University of Colorado’s Denver School of Medicine and at UT Southwestern Medical Center in Dallas, Texas.
Dr. Terlecki’s publications cover multiple areas of trauma and reconstruction and his research is focused primarily on models of wound healing and regeneration in the lower genitourinary system. Dr. Terlecki’s areas of expertise include urethral stricture disease, male sexual dysfunction, male incontinence, Peyronie’s disease, chronic testicular pain, hypogonadism, and infertility. He is a member of the Society of Genitourinary Reconstructive Surgeons (GURS), a member of the American Urological Association (AUA), and past president of the North Carolina Urological Association (NCUA).
