So you think you need . . . Circumcision:New kinds of surgery

Y-V-plasties is the latest of a number of procedures to preserve the foreskin in adults with phimosis. Performed under local anaesthesia, a number of incisions are made in the outer layer of skin and in the inner layer of skin. The foreskin is then reset and held in place with stitches. The procedure has a high rate of success, with only one out of 44 patients reporting a recurrence of the condition (Br J Urol, 1984; 56: 319-21).

However, as with other techniques that involve cutting skin on the penis, there is the potential for injury.

* Manual separation with local anaesthesia. In many cases of tight foreskin, separation of the preputial adhesions that attach the prepuce to the underlying skin is all that is needed. The procedure is pain-free for the majority of patients, though a few may feel some discomfort. The patient or his parents are then advised to fully retract the foreskin and apply petroleum jelly at bathtime every day, for seven days, followed by a further week of retraction while in the bath (BMJ, 1988; 297: 590-1).

The procedure is cheap, quick to perform and successful, with only one boy out of 39 requiring a repeat operation.

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Written by What Doctors Don't Tell You

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