1
|
Limited Dorsal Slit Preputialplasty for Management of Phimosis in Children. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
2
|
Hotonu S, Mohamed A, Rajimwale A, Gopal M. Save the foreskin: Outcomes of preputioplasty in the treatment of childhood phimosis. Surgeon 2019; 18:150-153. [PMID: 31548120 DOI: 10.1016/j.surge.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/09/2019] [Accepted: 08/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Symptomatic phimosis is a common childhood urology complaint. Circumcision was traditionally the treatment of choice, but its popularity in cases of non-scarred phimosis has been superseded by more conservative methods like preputioplasty. We sought to examine outcomes of preputioplasty for the treatment of non-scarred pathological phimosis in two UK paediatric surgery tertiary centres. METHODS Retrospective case series selecting cases performed in both departments over a 4 year period (January 2012-December 2015). INCLUSION CRITERIA non-scarred pathological phimosis treated with preputioplasty. EXCLUSION CRITERIA diffuse scarring of foreskin or presence of balanitis xerotica obliterans (BXO), preputioplasty performed as part of hypospadias repair. Outcome measure was treatment success as evidenced by fully retractile prepuce at follow up. Follow up occurred between 3 and 24 months. RESULTS We identified 126 patients, 6 were excluded due to the above criteria. Median age was 13.4 years (range 10 months-18 years). Median follow up was 13 months (range 3-24 months). 115 patients (96%) had successful treatment as evidenced by satisfactory post-operative cosmesis and complete resolution of phimosis at follow up. Recurrence of phimosis occurred in 5 patients (4%). Mean time of recurrence was 6 months, with a median age of recurrence of 15.3 years (range 10.7-16.7 years). All patients with recurrence were successfully treated with circumcision. CONCLUSION Foreskin conserving methods like preputioplasty are a valid option in the treatment of non-scarred pathological phimosis.
Collapse
Affiliation(s)
- Sesi Hotonu
- The Great North Children's Hospital Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Ahmed Mohamed
- The Great North Children's Hospital Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Ashok Rajimwale
- Leicester Children's Hospital Infirmary Square, Leicester, LE1 5WW, UK.
| | - Milan Gopal
- The Great North Children's Hospital Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| |
Collapse
|
3
|
Angotti R, Molinaro F, Ferrara F, Pellegrino C, Bindi E, Fusi G, Messina M. Preputialplasty: can be considered an alternative to circumcision? When, how, why? Experience of Italian centre. Gland Surg 2018; 7:228-233. [PMID: 29770316 DOI: 10.21037/gs.2018.02.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Phimosis is a condition in which the foreskin cannot be portrayed on the glans. It is a physiological and common condition in the pediatric age. The pathological form derives from an inflammatory or traumatic lesion. Circumcision is the most common surgical treatment of phimosis but it is a controversial practice, especially in occidental world. Methods We enrolled 61 patients with pathological phimosis (22/balanoposthitis, 18/painful erection, 21/urinary discomfort) between 2015-2017. Results All patients underwent preputialplasty. Conclusions Various alternatives to circumcision have been described, as manual retraction therapy, topical steroid therapy, and many types of preputialplasty. We report our technique.
Collapse
Affiliation(s)
- Rossella Angotti
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Ferrara
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Chiara Pellegrino
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Edoardo Bindi
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giulia Fusi
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| |
Collapse
|
4
|
Abstract
OBJECTIVE To evaluate the functional and cosmetic result of modified-triple incision preputial plasty for surgical management of phimosis in children. MATERIALS AND METHODS This prospective study involved all consecutive children (age 3-15) with phimosis, managed at our Institution in a one-year period. All patients unable to retract the foreskin and symptomatic with episodes of posthitis or balanoposthitis or ballooning of the foreskin with voiding were initially included. After a two-month trial of topic corticosteroids treatment, for patients refractory to conservative ointment treatment, "trident" preputial plasty was offered. This procedure combines two lateral Z-plasty and one middle Y-V plasty. All the procedures were performed as a day care, in general anaesthesia by two senior surgeons. Outpatient follow-up controls were scheduled at 1 and 2 week, 1, 6 and 12 months after surgery, respectively. RESULTS A total of 41 patient were enrolled. Mean operative time was 24 minutes (range 15-43). At 12-month follow-up, all but one patients (97.6%) was able to retract the prepuce. Cosmetic and functional results were satisfactory. CONCLUSION In selected group of children with phimosis, the "trident" preputial plasty provided excellent cosmetic and functional result. Adequate retraction of the prepuce by the patients soon after surgery is mandatory.
Collapse
|
5
|
Stewart GD, Gruthölter J, Donat R. Adult prepuceplasty: comparison of outcomes of standard prepuceplasty and foreskin Z-plasty. Urology 2012; 80:946-50.e1. [PMID: 22921703 DOI: 10.1016/j.urology.2012.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/15/2012] [Accepted: 06/18/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the clinical and patient-reported outcomes from standard prepuceplasty and foreskin Z-plasty. METHODS Consecutive standard prepuceplasty (n = 22) and Z-plasty (n = 12) procedures performed from September 2005 to December 2010 were analyzed. The patient and operative data were collated, together with the results of a patient questionnaire inquiring about the postoperative complications, postoperative pain, remaining foreskin tightness in the flaccid or erect penis, cosmetic appearance after surgery, and the need for later circumcision. RESULTS The median follow-up period was 26 months for standard prepuceplasty and 16 months for Z-plasty. Of the 22 patients in the standard prepuceplasty group and 12 patients in the Z-plasty group, 5 (22.7%) and 1 (9.1%) requested circumcision (P = .33), respectively. One man in each group underwent revision standard prepuceplasty. Patients undergoing the 2 procedures reported no significant differences for the questions relating to postoperative pain and foreskin tightness in the flaccid or erect penis. However, the cosmetic appearance after Z-plasty, assessed using a Likert scale question, were "good" or "very good" compared with "acceptable" for the standard group (P = .005). CONCLUSION Prepuceplasty can be used successfully in well-selected patients. In the present series, 82% of men avoided circumcision. Z-plasty resulted in fewer circumcisions and a significantly better cosmetic appearance than standard prepuceplasty.
Collapse
Affiliation(s)
- Grant D Stewart
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | | | | |
Collapse
|
6
|
Wilkinson DJ, Lansdale N, Everitt LH, Marven SS, Walker J, Shawis RN, Roberts JP, Mackinnon AE, Godbole PP. Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans. J Pediatr Surg 2012; 47:756-9. [PMID: 22498393 DOI: 10.1016/j.jpedsurg.2011.10.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/03/2011] [Accepted: 10/18/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period. METHODS Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes. RESULTS One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034). CONCLUSION Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.
Collapse
Affiliation(s)
- David J Wilkinson
- Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Shahid SK. Phimosis in children. ISRN UROLOGY 2012; 2012:707329. [PMID: 23002427 PMCID: PMC3329654 DOI: 10.5402/2012/707329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
Abstract
Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery.
Collapse
Affiliation(s)
- Sukhbir Kaur Shahid
- Consultant Pediatrician and Neonatologist, Shahid Medical Centre, Mumbai-400 077, India
| |
Collapse
|
8
|
Lumen N, Hoebeke P, Oosterlinck W. Ventral longitudinal stricturotomy and transversal closure: the Heineke-Mikulicz principle in urethroplasty. Urology 2010; 76:1478-82. [PMID: 20951413 DOI: 10.1016/j.urology.2010.06.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/08/2010] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the Heineke-Mikulicz principle in urethral surgery and to evaluate preliminary surgical and functional outcomes of this technique. METHODS Ten patients (of a cohort of more than 400 patients treated with urethroplasty during a 7-year period) with a urethral stricture were treated using the Heineke-Mikulicz principle: a ventral longitudinal stricturotomy was performed with transversal closure of the urethra. Only patients with a short (<1 cm), not too narrow or fibrotic stricture at the bulbar urethra or fossa navicularis were considered as appropriate candidates. At closure of the study, all patients were sent a questionnaire about the functional outcome of the procedures. This included questions about postoperative shortening, chordee, postvoid dribbling, ejaculatory disturbances, erectile dysfunction, and penile sensitivity. RESULTS Mean follow-up was 46.6 months (range: 15-79 months). There were no immediate or early postoperative complications. Nine of 10 patients (90%) were successfully treated. On the questionnaire, 1 patient reported mild postoperative chordee and shortening, and 1 patient complained of postvoid dribbling. None of the sexually active patients reported ejaculatory disturbances, erectile dysfunction, or diminished penile sensitivity. CONCLUSIONS The preliminary surgical and functional results with the Heineke-Mikulicz principle are promising. Larger cohorts of patients are needed for further evaluation.
Collapse
Affiliation(s)
- Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | | |
Collapse
|
9
|
Méndez-Gallart R, Estévez E, Bautista A, Rodríguez P, Taboada P, Armas AL, Pradillos JM, Varela R. Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children. J Pediatr Surg 2009; 44:2048-53. [PMID: 19853772 DOI: 10.1016/j.jpedsurg.2009.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/11/2009] [Accepted: 06/01/2009] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study is to evaluate bipolar scissors circumcision by comparing it with standard freehand scalpel procedure. PATIENTS AND METHODS Data were analyzed from a prospective, randomized study, comparing 2 different surgical techniques for pediatric circumcision: the bipolar diathermy scissors circumcision technique with those of a conventional scalpel technique. A total of 230 pediatric patients younger than 16 years (115 in each arm of the trial) who were undergoing circumcision were reviewed prospectively. Operative time, surgical bleeding, complications, and postoperative morbidity were analyzed. Differences between bipolar scissors circumcision and conventional surgery were compared. RESULTS Median blood loss for bipolar circumcision was 0.2 mL (range, 0-0.8 mL) compared with 2.1 mL in the standard group (range, 0.9-4.2 mL) (P < .001). Operative time in the bipolar diathermy treated group was significantly decreased compared with conventionally treated patients (10.8 +/- 1.2 vs 19.1 +/- 2.6 minutes; P < .01). Early and late postoperative morbidity were significantly decreased in circumcised patients who underwent the bipolar circumcision technique as compared with those who underwent the conventional approach regardless of the postoperative edema (22 vs 10; P = .02). CONCLUSIONS Bipolar scissors circumcision approach is an effective and safe procedure alternative to the standard scalpel technique in pediatric circumcision with no significant morbidity.
Collapse
Affiliation(s)
- Roberto Méndez-Gallart
- Department of Pediatric Surgery, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Munro NP, Khan H, Shaikh NA, Appleyard I, Koenig P. Y-V Preputioplasty for Adult Phimosis: A Review of 89 Cases. Urology 2008; 72:918-20. [DOI: 10.1016/j.urology.2008.06.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/19/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
|
11
|
Kayes O, Li CY, Spillings A, Ralph D. Frenular Grafting: An Alternative to Circumcision in Men with a Combination of Tight Frenulum and Phimosis. J Sex Med 2007; 4:1070-3. [PMID: 17451486 DOI: 10.1111/j.1743-6109.2007.00478.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Men suffering from frenular scarring and stricturing with associated phimosis are traditionally treated with circumcision. In men wishing to retain their foreskin, the treatment options are limited by this dual pathology. Frenuloplasty alone is contraindicated in this clinical setting. AIM To demonstrate the utility of frenular grafting in patients with a tight frenulum and concomitant phimosis who wish to retain their foreskin. METHODS Six men were included in the study. Presenting symptoms included bleeding (N = 2) and pain/phimosis (N = 6). Median age is 27 years (25-34 years). All men were healthy and sexually active. We describe a refined technique involving the excision of scarred and redundant frenular tissue and the insertion of a skin graft to the area. MAIN OUTCOME MEASURES All patients were assessed for graft viability, functional/symptom improvement, time to penetrative intercourse, and overall satisfaction. RESULTS All men received an interposition skin graft with 100% viability, with no revision surgery required. Postoperatively, all men were sexually active and able to retract their foreskin. CONCLUSIONS Cosmetic outcomes are encouraging and painless sexual intercourse is attainable in this difficult group of patients.
Collapse
Affiliation(s)
- Oliver Kayes
- The Institute of Urology-Andrology, Euston Road, London, UK
| | | | | | | |
Collapse
|
12
|
|
13
|
Lane TM, South LM. Triple incision to treat phimosis in children: an alternative to circumcision. BJU Int 2004; 93:635. [PMID: 15008747 DOI: 10.1111/j.1464-410x.2004.4686_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
|