"Trident" preputial plasty for phimosis in childhood

Phimosis in Adults: Narrative Review of the New Available Devices and the Standard Treatments

BACKGROUND

Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available.

AIM

To provide the first review summarizing the available options for the treatment of adult phimosis.

METHODS

A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 and December 2022 was performed using the search terms "phimosis AND treatment".

RESULTS

A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. Conservative treatment is an option. and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems to be providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. Several techniques of preputioplasty and use of in situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to traditional circumcision. Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented.

CONCLUSION

Many conservative and surgical treatments are available for the treatment of adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness.

Efficacy of three types of circumcision for children in the treatment of phimosis: A retrospective study

Phimosis is a common condition of the urinary system in children and often requires surgical treatment. However, the optimal method of circumcision for children has not been determined. Herein, we analyzed the efficacy of 3 circumcision methods for children with phimosis. A retrospective analysis of 112 cases of pediatric phimosis after circumcision was conducted at our hospital. Among them, 36 cases were subjected to conventional operation (group A), 43 cases to ring circumcision (group B), and 33 cases to suturing device circumcision (group C). The duration of operation, amount of bleeding, pain, complications, healing time, and the satisfaction of the guardians were calculated. The operation time of group B and C was (6.26 ± 1.31) min and (7.67 ± 1.29) min, respectively, which was shorter than group A (27.42 ± 2.42) min (P < .05); besides, group A had the most blood loss volume, (9.67 ± 1.67) mL, and group B was the least (1.26 ± 0.44) mL (P < .05); group B had the strongest postoperative pain (4.05 ± 0.37), the longest pain time (6.84 ± 1.29) days, and the longest healing time (21.84 ± 4.23) days (P < .05). Postoperative complications were lowest in group C (11.11% vs 20.93% vs 6.06%), satisfaction of guardians was highest in group C (86.11% vs 85.27% vs 89.99%), but the difference was not statistically significant (P > .05). Three types of surgical procedures present with advantages and disadvantages. The conventional surgery led to longer operation time and more bleeding but did not require special medical equipment and was easy to carry out; ring surgery had the shortest operation time, the least bleeding, accompanied by the longest recovery time and pain duration; the complications of the suturing device were the least, the parents had the highest degree of satisfaction, however, it also needs a specific suturing device. Therefore, each type had its distinctive characteristics and may be flexibly selected based on their own conditions.

Preputioplasty as a surgical alternative in treatment of phimosis

Preputioplasty denotes various surgical techniques directed at resolving phimosis without the need for radical or partial circumcision. This narrative review summarizes the best-known surgical techniques of preputioplasty. A MEDLINE and EMBASE-based literature search of original manuscripts and case reports published in English has been carried out using the following key words: “circumcision”, “partial circumcision”, “phimosis”, “paraphimosis”, and “preputioplasty”. Six different procedures are explored in more detail and illustrated. The complication rates of all surgical procedures presented here are reported to be low. In cases of medical (rather than cultural and religious) indications, foreskin-preserving procedures present useful alternatives to circumcision in the routine clinical practice of urologists and pediatric surgeons.

Preputialplasty: can be considered an alternative to circumcision? When, how, why? Experience of Italian centre

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.