Dorsal slit of foreskin- alternative treatment

Information about dorsal slit of foreskin from The British Association of Urological Surgeons (BAUS)- recently published June 2017

Alternative treatment for tight foreskin

Key Points

• This is a short-stay procedure to relieve a tight foreskin

• It is sometimes used in emergency situations when the foreskin is swollen or stuck in a retracted position (paraphimosis)

• It can be used as an alternative to circumcision in patients who are unfit or are unwilling to be circumcised

• We make a single incision along the length of your foreskin to expose the head of your penis without removing any tissue

• The cosmetic appearance after the procedure is not as good as it is after circumcision

Circumcision, to remove the foreskin completely, may be needed at a later stage

plesse see following full document online.  

Dorsal slit foreskin. June 2017 

Buried penis, hidden penis, inconspicuous, concealed or webbed penis

"Although subtly different, we consider the inconspicuous, concealed, hidden or webbed penis as minor variations of the same entity. All occur due to minor anomalies of the preputial ring. Specifically, the webbed penis represents an encroachment of the scrotal tissue onto the ventral portion of the penis. This condition results in considerable shortening of the ventral penile shaft skin compared with the dorsal skin. This can occur in two forms: (1) narrowing of the preputial ring proximal to the glans, resulting in a concealed penis, or (2) in the absence of preputial narrowing, resulting in a greater proportion of the penile shaft skin provided by he inner preputial skin than the external preputial skin (“megaprepuce”). Both of these become important when considering circumcision. In these cases, circumcision performed with a Plastibell or a Gomco clamp results in excessive removal of penile shaft skin. If the circumcising incision is made along the narrow portion of the prepuce, a cicatrix will form that will “trap” the penis. This condition (trapped penis) results in a tight, firm preputial ring that requires surgical release with a rotational flap of the dorsal inner preputial skin to the ventrum of the penis.

These conditions are all relatively common. A number of successful surgical approaches address these conditions. Our preference is to harvest a flap of inner preputial skin on its vascular pedicle, transfer that pedicle to the ventrum of the penis, and suture it in place. In this way, the natural narrowing of the preputial ring is opened and the appropriate amount of residual shaft skin and inner preputial skin can then be removed to provide for good cosmesis.

When any of these conditions are noted, it is important to refrain from newborn circumcision. Circumcision will not address the fundamental problem of proximal narrowing of the prepuce that all of these boys share."

Source:

Fundamentals of

Pediatric Surgery 2011

Edited by

Peter Mattei, MD, FAAP, FACS

The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Chapter 84

Penile Anomalies and Circumcision

BY Douglas A. Canning

Dr. Khan has expert in dealing with this condition and has 23 years experience in dealing this condition. 

Adult circumcision with glue and stitches under local anaesthesia at Thornhill Circumcision Centre, Luton

The widespread acceptance of adult local anaesthesia circumcision in the community remains debatable. We report outcomes (Glue and Stiches) from a dedicated GP clinic over two year period. Patient demographics, indications and postoperative complications were recorded prospectively.

Of 373 circumcisions (glue n=269 and stitches n=103), 230 patients had therapeutic indications including 63 (17%) balanitis xerotica obliterans and 11 (2.9%) had minor complications (infection n=6, bleeding n=2 and redo n=3) with no significant difference between the two groups.

Circumcision performed in adults remains a safe surgical option under local anaesthesia in dedicated GP surgeries.

Dr. A R Khan has performed 143 cases during this period. Four cases have a minor infection and one case has a minor bleeding. This means most of the cases have an excellent result after adult circumcision (Glue n=134 and stitches n=9). Glue circumcision in adults gives result with less pain and excellent cosmetic results. 

Adult circumcision : Are there any alternative treatments for tight foreskin in adults?

Phimosis or tight foreskin:  Are there any alternative treatments to circumcision ?

Under some circumstances, other alternative treatments may be considered to keep your foreskin but adult circumcision remains the most common treatment option to relieve your symptoms of tight foreskin. Alternatives to a circumcision include:

• Frenuloplasty – this is an operation to cut and lengthen your frenulum, which is the small tag of skin on the underside of your penis, between your foreskin and the shaft of your penis. If the frenulum is short or torn, you may have problems pulling your foreskin back. Frenuloplasty may relieve the symptoms. 

• Dorsal slit – in this procedure the foreskin is cut on the top of the foreskin to widen and loosen it, so it can be pulled back more easily. Cosmetic result showed fish mouth like appearance. 

• Prepuceplasty – this is a plastic operation called V-Y plasty or Z- plasty. This  procedure is more complicated than a circumcision. The foreskin is cut and stitched to widen it. This is not indicated in case of balanitis xerotica obliterans ( BXO). 

  Mr. Khan  can explain these treatments if they are suitable for you.