Preputioplasty

A plastic surgical operation on the prepuce or foreskin of the penis

Article by Dr Matt Khan, Surgeon/Urologist, MBBS, FRCS, FEBPS, FRCS(paeds)  Email: dr.matt.khan@yahoo.com

In this article we discuss Phimosis, its types and a treatment for Phimosis called Preputioplasty

What Is Phimosis? What Are Its Types and How to Heal It?   Also read What is Frenuloplasty?

What is Phimosis?

Phimosis is a condition where the penis’ foreskin cannot be retracted past the glans. Under the foreskin, a balloon-like swelling might take place during urination and it could be painful to teenagers and adults in the course of erection or sexual intercourse. Howbeit, some doesn’t feel pain at all but the affected men are at huge risk of balanitis, which is an inflammation of the glans and other complications.

You may have noticed the tightness of your foreskin and it might make you feel uncomfortable. Don’t fret because many of you are on the same dilemma. A study conducted in 1968 that even after the age of 17, there’s still about one percent of men having a hard time retracting their foreskin.

Unlike what you think, Phimosis is not a disease. In fact it’s somewhat normal to most men who have it. Nevertheless, there are some men who no longer feel comfortable with it. Some are worried that their foreskin might get stuck and some may experience pain during sexual intercourse.

   

What are the types of Phimosis?

Medical research for Phimosis is mostly in children although it is normal that the foreskin is not retractable at a young age. This is resolved by the age of seven until the age of sixteen. Over a decade ago, researchers Kikiros and others have studied phimosis’ treatment in boys through stretching on a daily basis as well as using steroid creams. These people made this classification in illustrating the cases that they studied upon.

The types of Phimosis are the following:

            Type 0 – Full retraction, loose at the back of the glans, or easy retraction, limited only by congenital adhesions to the glans.

            Type 1 – Foreskin can be retracted fully and its only tight behind the glans

            Type 2 – The glans is partially exposed, prepuce limiting factor

            Type 3 – Partial retraction of the foreskin, visible meatus

            Type 4 – Slight retraction of the foreskin, but several distances stays between the tip and glans, which is neither meatus nor glans can be shown

            Type 5 – Retraction is not possible at all

Tight foreskin can be solved with consistent stretching on a daily basis. However, not all men have enough time and patience for a daily stretching. Thus, surgery would be the best option.

What is Preputioplasty?

   Also known as limited dorsal slit with transverse closure, Preputioplasty or prepuce plasty is a treatment for Phimosis. The foreskin of the penis or the prepuce will have to undergo a plastic surgical operation so that a tight non-retractile foreskin will be widened.

This can be done on an outpatient basis through a local anaesthesiologist in a doctor’s office and this is conservative, less invasive and non-traumatic. Additionally, this operation will also heal faster with little to no cosmetic changes on the penis’ appearance.

What are the methods of performing Preputioplasty?

Preputioplasty can be performed by Z-plasty, which is used in reconstructive surgery so that the constricting scar tissue caused by traumatic burns can be loosened though Z-plasty and Y-plasty entails a degree of surgical complexity, which general practice physicians don’t have. Generally, it consists one or more short longitudinal incisions that discharge the stenosis or the tissue’s constricting ring in the penis’ foreskin and are closed or stitched crossways.

Figure 1

Penis with tight phimotic ring which makes the foreskin difficult to retract.

 Figure 2

Foreskin retracted under anaesthetic with the phimotic ring or stenosis constricting the shaft of the penis, which creates a “waist.”

 Figure 3

Incision is closed laterally.

Figure 4

Penis with the loosened foreskin is replaced over the glans

In the alternative to suturing, "haemostasis [has been successfully] performed [in children] with a heated probe using the flame of an alcohol lamp or with bipolar electrodiathermy. In Figure 3, there’s only one incision exposed and in the instance that two or more incisions are performed, it will avoid a V-shaped notch at the foreskin’s opening when there is no erection of the penis.

Diagram showing Phimotic ring enlarged by plastic surgery with a vertical incision which is closed laterally.

Moreover, if incisions are positioned on the phimotic ring’s sides, the essential cosmetic effect is better. To guarantee a better cosmetic result, it is highly recommended that the subcutaneous tissue be destabilized.

Is Preputioplasty a good alternative to circumcision?

In the 90s, a study conducted on both Preputioplasty and circumsion between boys who needed a surgery because of their tight nonretractile foreskin and they were offered either to undergo a circumcision or Preputioplasty. Those who chose to have a Preputioplasty, only about eight percent of them who had to stay overnight following the operation and there was no bleeding occurred. With boys who chose to have a Preputioplasty, 20 percent of them had to stay overnight, 14 percent had anesthetic complications and six percent were required another operation because of bleeding.

The parents of these boys have concluded that the gruesome effect was absolutely less and with shorter duration for those who had Preputioplasty. They were impressed with the lasting results of the operation, which is easier to perform allowing the foreskin to fully mobilized, functions quickly and provides great cosmetic result.

Over the next few months, the boys who had Preputioplasty experienced less discomfort compared to those who had circumcision. Majority of the boys with Preputioplasty were able to freely mobilize their foreskin with no soreness soon after the surgery.

Preputioplasty was scored excellent 57.5 percent being excellent, 27.5 percent being good and 15 percent being acceptable. Circumcision got a score of 47.5 being excellent, 42 percent being good and 10.5 percent being acceptable.

With the cosmetic appearance of the boys who had Preputioplasty, the parents gave a rate of 70 percent for normal, 25 percent for acceptable and five percent for slightly scarred. For circumcision, parents gave a rate of 26 percent for normal penis appearance, 53 percent for acceptable and 21 percent slightly scarred.

In Europe, Preputioplasty is widely used because of its simplicity. It is way faster and safe operation with ease and with less complication because of the avoidance of the penis’ frenular area. It is the safest method of preserving preputial function of the boys who are in need of surgery for relief of a tight but unscarred foreskin.

Websites on Phimosis and Preputioplasty

Preputioplasty Wordpress

4 Stages of Phimosis

Phimosis Journey

Preputioplasty - Wikipedia

How to loosen foreskin

Copyright 2017  Dr Matt Khan, Surgeon/Urologist, MBBS, FRCS, FEBPS, FRCS(paeds)