www.surgicalnotes.co.uk

Indications

1. Medical
   • Phimosis (intractable foreskin) - congential adhesions, poor hygeine, balanitis causing foreskin to become thickened and tight
   • Paraphimosis (trapped foreskin behing the glans)
   • Recurrent UTIs
2. Non-medical

Contraindications

•  Hypospadius

Procedure

1. Informed consent, prepared
2. Supine position, GA / LA dorsal penile block
3. Free foreskin from glans with forceps
4. Pull foreskin down over glans; apply straight forceps, divide between forceps to ~5mm of corona
5. Incise laterally, circumferentially towards frenulum
6. Excise
7. Transfix frenulum
8. Two layers of skin brought together with interrupted absorbable sutures
9. Loose vaseline dressing + "sporan"

Plastibell (Hollister) technique

Complications

1. Immediate
   • Bleeding / haematoma
   • Infection
   • Urine retention
   • Glans injury
   • Ischaemia / necrosis of penis
2. Late
   • Poor cosmesis
   • Urethrocutaneous fistula
   • Meatal stenosis
   • Psychological morbidity