Diagnostic Challenges in Donor Studies: A Case of Buried Penis Secondary to Giant Inguinoscrotal Hernia and Scrotal Lymphedema

Buried or hidden penis, also known as buried or hidden penis syndrome, is a condition where the penis is normal in size, but concealed beneath the abdomen, thigh, or scrotum. Seen in children due to congenital abnormalities, post-circumcision scarring, or obesity, buried penis in adults is less well-defined and often linked to obesity, prior surgical history, or lymphedema. Diagnosis is primarily clinical and relies heavily on detailed patient history and thorough physical examination, which is unattainable when studying a donor. We report a case of an 86-year-old male donor whose penis was not externally visible as it was buried inside dilated scrotal sac secondary to lymphedema in the setting of a giant indirect inguinoscrotal hernia. Given our findings, we hypothesize that tension created by the hernia pulling on the skin, as demonstrated by scrotal sac dilation combined with subsequent/concurrent lymphedema, likely contributed to what appeared to be a buried penis. However, the lack of accessible information on this cadaver, including a detailed past medical and surgical history, limits the certainty of a buried penis diagnosis in this context. This case is unique in exploring the possible relationship between a giant inguinoscrotal hernia and a buried penis but without the detailed patient history typically required for a definitive buried penis diagnosis. Our findings highlight the limitations of diagnosing a buried penis in donor studies and suggest that anatomical changes other than the previously well-defined historical criteria should be considered as likely contributors to adult-acquired buried penis.