Indications:
- Phimosis
- Paraphimosis
- Recurrent balanitis or balanoposthitis
- Lesion suspicious for malignancy
- In children – prevention of UTI with urological abnormalities
- In high risk countries – prevention of HIV and penile cancers
- Elective or religious reasons
Contra-indications:
- Bleeding diathesis
- Hypospadias
Things to mention:
- Penile block + GA
- Mark incisions – level of coronal sulcus, and about 5 mm from glans.
- Excise skin with judicious haemostasis
- Reconstruct with 4-0 vicryl rapide – 12 and 6 o’clock stays first to ensure alignment
- Chlorsig ointment and mildly compressive dressing
Risks:
- Bleeding
- Infection
- Dehiscence
- Poor cosmesis
- Redundant excess remaining foreskin, or too much skin excised
- Necrosis
- Changes in sensation – hypersensitive or hyposensitive – must be consented for
- Meatal stenosis
- Urethral injury
- Glans injury
- Anaesthetic risks
Circumcision alternatives – frenuloplasty / preputioplasty
Frenuloplasty:
- Transverse incision of the frenulum
- Longitudinal closure with lengthening of the frenulum – interrupted rapide
- Indicated for those with frenulum symptoms but desire preservation of the foreskin
Taken from BAUS handout
Preputioplasty:
- Good functional outcomes avoiding circumcision in about 80 %.
- Standard preputioplasty – multiple longitudinal incisions with transverse closure (opposite of frenuloplasty) – mean 4 incisions.
- Alternatives – single incision as below.
