Saving the normal foreskin

Phimosis: is circumcision necessary?

Circumcision has been the traditional treatment for phimosis, but now is not the only management option, the best of which appears to be topical steroid application. Importantly, the literature suggests that phimosis probably is over-diagnosed, indicating that a prospective, randomized controlled study is needed to compare the non-circumcision options. Such a study would require consensus on the diagnostic criteria for phimosis; therefore, a more exacting definition would be needed and is suggested. Despite the non-controlled data on medical treatment of true phimosis, there seems little doubt that surgical intervention is not needed for all male infants with adherence of the foreskin to the glans, a non-retractable foreskin or, indeed, true phimosis.

Prepuceplasty: an alternative to circumcision

The operation of prepuceplasty overcomes phimosis in children while conserving the foreskin. The narrowed preputial outlet is incised longitudinally and repaired transversely. When appropriate, this minor procedure produces lasting relief of the deformity, as shown in 55 patients followed for up to 20 years.

Complications of circumcision

Circumcision remains a common operation, with over 30,000 procedures performed annually in the UK, mostly on children. The British Medical Association has recommended that circumcision should be performed only for medical reasons. Despite this, controversy exists over whether too many circumcisions are being performed. Are patients being exposed to an unnecessary operation? It may be argued that in doubtful cases it is easier to proceed to circumcision on the assumption that the attendant risks are low, but the operation is associated with a definite morbidity and rare deaths have been reported. This review considers the spectrum of complications that may result from circumcision and discusses the possible aetiological mechanisms.