To compare the incidence of penile cancer and urethral stricture disease in patients undergoing surgical correction of adult-acquired buried penis disease whose penis cannot be adequately exposed for examination preoperatively with those whose penis can be fully exposed and examined.

We performed a single-arm retrospective cohort review of 203 patients who underwent adult acquired buried penis repair at single institution between 2013 and 2025. The ability to exhume patients’ penises preoperatively was determined using electronic medical record photo review, operative reports, and outpatient documentation. The presence of lichen sclerosis or penile cancer was determined by a genitourinary pathologist. Statistical analysis was performed using two-tailed two sample T-test and Odds Ratio.

The penile skin of patients whose penises could not be exposed preoperatively were significantly more likely to harbor lichen sclerosus than those whose penis could be exposed (28.4% vs 13.8%, OR 2.89, 95% CI 1.38, 6.08). There was no significant difference between penile cancer risk (6.5% vs 2.5%, OR 2.71, 95% CI 0.56, 13.12) or stricture risk (26.3% vs 35.0%, OR 1.51, 95% CI 0.81, 2.81).

Patients with genitals who cannot be exposed for full preoperative examination are at higher risk for premalignant conditions. Clinicians should explicitly note the diagnostic uncertainly and increased risk of adverse pathology in patients whose genitals cannot be exposed as part of the shared decision-making process. Given the risks of observation in the setting of limited examination, upfront surgery should be strongly considered in this population.