Acquired buried glans penis mimicking traumatic penile amputation following circumcision: three pediatric case series

Background: Circumcision is one of the most commonly performed surgical procedures worldwide. Although generally safe, severe complications may occur, particularly when performed in non-medical settings. Buried glans penis secondary to post-circumcision cicatricial scarring is a rare but potentially misleading complication that may simulate traumatic penile amputation. Method: This study was designed as a descriptive three-case series. It was conducted within the Department of Pediatric Surgery and Urology at ⁠Kampala International University Teaching Hospital (KIU-TH) in Ishaka, Bushenyi District, Uganda. Case presentation: We report three children referred to our institution with suspected penile amputation following circumcision performed by a religious practitioner, in whom subsequent clinical assessment and surgical exploration demonstrated preservation of the glans beneath cicatricial tissue and adhesions. The children were aged 17 months, 37 months, and 36 months, respectively. The patients presented approximately 1–3 months after circumcision. The first case presented with urinary retention of 1 week’s duration requiring suprapubic urinary diversion; the second case had a weak urinary stream, while the third presented with concerns for an amputated glans. Clinical examination in all cases revealed an apparent loss of the glans penis with dense cicatricial tissue covering the distal penis, raising suspicion of penile amputation. Surgical exploration, however, demonstrated that the glans was intact but concealed beneath dense adhesions and scar tissue. All patients underwent penile exploration, adhesiolysis, reconstruction, and revision circumcision. Postoperatively, all patients had successful outcomes, with restoration of normal penile appearance and satisfactory urinary function. They were discharged after catheter removal, having voided without difficulty. At 3-month follow-up, all patients remained free of urinary complications, and their mothers reported high satisfaction with both the cosmetic and functional outcomes. Conclusion: When an inconspicuous penis is observed after surgery, the differential diagnosis can range from a simple trapped penis caused by cicatricial narrowing of the preputial opening, resulting in complete coverage of the glans by scar tissue, to the possibility of more extensive pathology, such as partial glans amputation, either acute or delayed. The treating institution should be equipped to manage all such findings intraoperatively, for example, through meatal reconstruction or glans resurfacing when indicated. Ultimately, a buried glans penis should be considered in children presenting with suspected penile amputation following circumcision; early recognition, referral, careful clinical evaluation, and timely surgical exploration can successfully restore urinary function and penile appearance while avoiding misdiagnosis and unnecessary psychological distress.