Preputioplasty

You have a tight foreskin that cannot be fully retracted (pulled back). This can cause problems with recurring infections of the foreskin area. Preputioplasty is unsuitable if your foreskin is scarred due to balanitis xerotica obliterans (BXO) or Lichen Sclerosus. Please see further information for BXO. 

There are three options for treating a tight foreskin without BXO or lichen sclerosus:

1. Observation or steroid cream– no specific treatment in mild cases or use of steroids may help.
2. Circumcision, which means that the foreskin is eradicated. The advantage of this operation is that once the foreskin is removed, you will not have any problem-related foreskin. The head of the penis is exposed permanently after the operation
3. Preputioplasty, which is simply a foreskin-releasing procedure. An incision is made on either side of the foreskin to widen it, thus allowing full retraction. This will allow you to retain your foreskin but at the same time be able to keep the area underneath clean. Y-V preputioplasty may be an excellent alternative to full circumcision for boys over 16 years and adults with tight foreskin who want to keep their foreskin.
4. Dorsal Slit of the foreskin: The dorsal Slit is performed by incising the top of the foreskin to relieve tight foreskin (phimosis). This is mainly done when the foreskin is stuck over the swollen head of the penis over the shaft of the penis, unfit or unwilling for circumcision.

Reference: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Dorsal%20slit.pdf

International Journal of Impotence Research reported in December 2021 that circumcision is the ideal treatment for phimosis and aims to remove the entire foreskin. Alternative surgical treatments include different types of preputioplasty. Preputioplasty denotes various surgical techniques to resolve phimosis without complete or partial circumcision. Recent medical evidence (2021) summarises the best-known surgical operations of different types of preputioplasty for tight foreskin (phimosis)

Reference: IJIR: Your Sexual Medicine Journal; https://doi.org/10.1038/s41443-021-00505-9

Benefits of Having a Preputioplasty

The benefit is that he retains foreskin but looks like a fish mouth appearance of foreskin.

Circumcision used to be a commonly practised operation in men and, on many occasions, was performed with excellent results.

Details of the Procedure

1. A urologist/surgeon usually performs the procedure under a local anaesthetic.
2. Local anaesthetic nerve blocks also provide post-operative pain relief
3. He divides the foreskin on the top across and re-stitch it lengthwise, which results in lengthening the ring of the foreskin.
4. He uses dissolvable stitches throughout, which usually disappear within two to three weeks.
5. He applies and seals the wound with glue, which sloughs off within ten days.
6. We usually wrap the penis in a loose bandage which you can remove after 1-2 days.

What Are the Risks, Consequences, and Alternatives Associated With You Having a Preputioplasty?

Most operations are straightforward; however, as with any surgical procedure, there is some chance of side effects or complications, such as:

Bruising and swelling generally happen. Significant swelling of the remaining foreskin underneath of penis (frenulum side) will develop during the first few days. This swelling may last for 2-3 weeks or longer.

Bleeding from the wound site (occurs in 2 – 3% of patients) is usually minimal and settles quickly. Infection can arise and is usually minor but possibly severe, with an incidence of less common—tenderness of the scar at the wound.

I am dissatisfied with the cosmetic result. Failure to improve your symptoms may result in the need for full circumcision.

Redo operation or full circumcision: >30% foreskin becoming tight again due to scarring after preputioplasty.

The best alternative for a tight foreskin is circumcision.

What Can I Expect When I Get Home?

• You will get some swelling and bruising of the penis, which may last several days
• All your stitches will disappear, usually within two to three weeks, but it may sometimes take a little longer
• Simple painkillers such as paracetamol or Ibuprofen are helpful if you have any discomfort
• Any dressing should fall off within 24 hours; if it does not, or if it becomes soaked with urine, it should be removed
• Keep the area dry for 48 hours; avoid soaking in a bath
• You should not swim or do any exercise for two weeks
• Try to keep your wound clean and dry after passing urine
• Apply a little Vaseline to the tip of your penis and around the stitch line to stop it from sticking to your clothing
• Wear tight-fitting clothing for two to three days
• You should retract your foreskin daily to maintain the benefits of the surgery after three days
• You will be given a copy of the letter, which should be given to your GP
• Any antibiotics or other cream you need to get from any pharmacy
• You should refrain from sexual activity (intercourse and masturbation) for up to four to six weeks

Smoking and Surgery: Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and make complications more likely after surgery.

Following three days of the operation, you must retract his foreskin each day to avoid the foreskin becoming tight again. If you are concerned about any of these risks or have further queries, please contact us immediately.

Note: This is the information for guidance only; it will not be a replacement for a professional opinion by Specialist Urologists. Please get in touch with us for video consultation £150 advice at +447527314081