Preputioplasty or prepuce plasty, also known as "limited dorsal slit with transverse closure", is a plastic surgical operation on the prepuce or
foreskin
In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the ...
of the
penis
A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...
,
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
A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).
''Stricture'' ...
) which has not expanded after
adolescence
Adolescence () is a transitional stage of physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated with the ...
.
Preputioplasty is a treatment for
phimosis in the alternative to
circumcision
Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Top ...
and radical
dorsal slit
A dorsal slit (often referred to in anthropology as superincision or supercision) is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue. An ancient practice, it has ...
* which is conservative, non-traumatic and less invasive and can be performed on an outpatient basis under local anaesthetic in a doctor's office and
* has the advantage of healing very quickly with little or no significant cosmetic alteration to the appearance of the penis.
Methods of performing preputioplasty
Preputioplasty may be performed by
Z-plasty
Z-plasty is a versatile plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. It can elongate a contracted scar or rotate the scar tension line. The middle line of the Z-shaped incision (the central ele ...
, 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
nbsp;—
In the alternative to suturing, "
emostasis
as been successfullyperformed
n childrenwith a heated probe using the flame of an alcohol lamp or with bipolar electrodiathermy."
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 be
undermined 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.
References
Further reading
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*
External links
Surgical technique{{Male genital procedures
Male genital surgery
Human penis