Adult acquired buried penis and bariatric surgery: a mighty motivator

Background: While adult acquired buried penis (AABP) is due to obesity, the literature suggests that weight loss may not provide much patient benefit. We aim to determine if weight loss leads to voiding, anatomic, and sexual symptom improvement in men with AABP who are undergoing bariatric weight loss surgery. Methods: We performed a retrospective, cross-sectional survey of men who underwent bariatric surgery at a single academic institution between 2009 and 2021. The survey assessed demographics, voiding function, anatomic function, and sexual function. Men were considered to have AABP if they answered "yes" to the question, "Have you ever had trouble exposing the penis to urinate or have sex?". Men were also shown a series of 5 pictures depicting varying severity of buried penis and asked to choose which photo best represents how they looked before the surgery and how they currently look. Pre-operative and post-operative symptoms were compared. Results: Of the 64 men who completed the survey, 11 (17%) met criteria for AABP. There were no significant differences in age, weight, body mass index (BMI), or weight loss between men with and without AABP. The average and median time from surgery to survey were 51.6 and 45.5 months, respectively. Baseline function was worse in the AABP group: only 8% could see their penis, 82% could urinate standing, 45% had issues with genital infections, 18% could not get an erection, 27% could not orgasm and 55% were not sexually active. For men without AABP, 40% could see their penis, all men were able to urinate standing, 9% had issues with genital infections, 11% could not get an erection, 6% could not orgasm, and 25% were not sexually active. After surgery, both groups reported improvement in voiding and anatomic function. Sexual function trends diverged with improvement seen primarily in the AABP group. The only statistically significant change was the ability to see the penis in men without AABP (40% to 91%, P