Retrospective analyses on preputioplasties in boys with pathological phimosis performed over the last 9 years.
Jikke Bosveld, Medical student, Rogier Schroeder, PhD, Paul Hornung, Medical student, Aart Klijn, PhD.
University Medical Centre Utrecht, Utrecht, Netherlands.
BACKGROUND: Phimosis is a condition of the foreskin in which the foreskin cannot be retracted by gentle manipulation. At birth this is physiological phenomenon but phimosis at advanced age can be pathological. Traditionally, after having applied corticosteroids, circumcision has been the operational treatment of choice. Over the recent years, there has been increasing resistance to circumcising children in variety of countries. As a consequence, there is an increasing trend towards performing a preputioplasty instead. Current literature does not provide a definite answer on which operative approach is preferable. Therefore, this study aims to look at the long-term effects of preputioplasty in children with phimosis. METHODS: A retrospective cohort-study was performed in all boys bellow the age of 18 suffering from phimosis, that underwent preputioplasty at our hospital between the 1st of January 2011 and the 1st of January 2020. Preputioplasty techniques performed involved a multiple Z-plasty, a Y-V plasty, a (multiple) dorsal slit or a multiple Y-V plasty. Children diagnosed with hypospadias or a buried penis, as well as patients with a previous foreskin operation were excluded. Preoperatively, the severeness of the phimosis was determined and subdivided in a normal phimosis/unknown group and the others having severe phimosis/pinpoint opening and/or scarring. The primary outcome of the preputioplasty was positive when the foreskin was retractable by gentle manipulation months after the operation. RESULTS: A total of 176 patients were included in our study. The mean age was 8.9 years (range 1 month to 18 years). There were 40 patients with complaints of (recurrent) balanitis. 62 of all patients had a severe phimosis. 21 of them were diagnosed with balanitis xerotica obliterans (BXO)/lichen sclerosis. In 12 of these boys this was proven by histopathology. Initially, 139 patients applied topical corticosteroids as the first treatment. Outcome of the preputioplasty was positive in 163 patients (93%). 29 of the patients were advised to apply corticosteroids post-operatively. Furthermore, 2 patients with a positive outcome did undergo an extra operation for adhesiolyses. A total of three patients showed complications. One patient developed an infection and two patients developed wound dehiscence. Out of the thirteen patients (7%) that were reported having a negative outcome circumcision was done in 8 cases, and a redo preputioplasty in 4. The last boy decided not to undergo more treatments because the inability to retract the foreskin was not bothersome. CONCLUSIONS: Surgeons treating pathological phimosis should master the surgical technique of a preputioplasty. It enables them to offer all surgical treatment options to their patients. Accordingly, in our clinic we have produced an instructional video on preputioplasty intended to help colleagues to master the surgical technique. This study shows that in a group of 176 boys with phimosis 163 had a retractable foreskin after preputioplasty. Complication rates were low. A preputioplasty is shown to be a feasible operative treatment option for pathological phimosis.
Back to 2021 Posters