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| Preputioplasty | |
|---|---|
 Phimotic foreskin retracted fromglans with stenosis creating a "waist" | |
| Specialty | Urology |
Preputioplasty orprepuce plasty, also known aslimited dorsal slit with transverse closure, is a plastic surgical operation on the prepuce orforeskin of thepenis,[1] to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a constriction (stenosis) which has not expanded afteradolescence.
Preputioplasty is a treatment forphimosis in the alternative tocircumcision and radicaldorsal slit
Preputioplasty may be performed byZ-plasty, also used in reconstructive surgery to loosen constricting scar tissue following traumatic burns.
However, Y-plasty and Z-plasty require a degree of surgical sophistication that physicians in general practice may lack.
More commonly it simply consists of one or more very short longitudinal incisions which release the stenosis–the constricting ring of tissue—in the foreskin and are closed transversely: [ | ] is closed and sutured as [ — ].
In the alternative to suturing, "[h]aemostasis [has been successfully] performed [in children] with a heated probe using the flame of an alcohol lamp or with bipolar electrodiathermy."[2]
Only one incision is shown in Figure 3; if two or more such incisions are made this will prevent a V-shaped indentation at the opening of the foreskin when the penis is not erect. If incisions are placed on the sides of the phimotic ring, the ultimate cosmetic result is better. It is also recommended that the subcutaneous tissue beundermined to ensure a better cosmetic result.
The opening of the foreskin is now normally wide enough for the foreskin to be easily retracted. The foreskin is also slightly shorter (by half the length of the longitudinal incisions which are now closed transversely) because the widening of the phimotic ring takes up some foreskin length.Studies from a large cohort in the Indian Subcontinent show a good acceptance and an interest for foreskin preservation when there is no religious indication to remove the foreskin.
Osmonov, D., Hamann, C., Eraky, A. et al. Preputioplasty as a surgical alternative in treatment of phimosis. Int J Impot Res 34, 353–358 (2022).https://doi.org/10.1038/s41443-021-00505-9https://www.nature.com/articles/s41443-021-00505-9