An Alternative Treatment for Phimosis

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Y-V preputioplasty can replace circumcision in men wanting to retain their foreskin, researchers say

 

PARIS—Y-V preputioplasty is a viable alternative to circumcision for men with phimosis who wish to preserve their foreskin, according to investigators in the UK.

 

Hassan Khan, MD, with Airedale GeneralHospital in Steeton, West Yorkshire, and his collaborators analyzed questionnaires completed by 30 men who had undergone Y-V preputioplasty for phimosis at their institution since 1995. Subjects were drawn from a cohort of 89 men in whom the procedure had been performed by a single surgeon. The median after age at the time of surgery was 29 years, and the median follow-up was four years.

 

Twelve patients (40%) said that they were very satisfied with their outcome and 10 (33%) said they were satisfied, the researchers reported here at the Société Internationale d'Urologie 29th Congress in Paris. Four (13%) were indifferent, and four (13%) said they were dissatisfied.

 

Twenty-one patients (70%) described their cosmetic result as good or very good, and 22 (73%) said that they would recommend the operation to a friend with a similar problem. Treatment dissatisfaction seemed to be associated with preexisting erectile dysfunction (ED) and failure to follow instructions to retract the fore-skin postoperatively.

 

Seven cases required revision surgery, which included Y-V preputioplasties in three patients, circumcisions in two, adhesion-division in one patient, and frenuloplasty in one patient. Two patients reported unresolved symptoms but have not undergone additional procedures.

Dr. Khan said that the study is the first to assess the outcome of a prepuce-sparing procedure in adults and cautioned against comparing this study with studies in pediatric populations. His study included more cases of secondary phimosis than studies involving children, although later presentation in adult patients may suggest less severe symptoms.  

 

In addition, there are significant technical differences in genital plastic surgery in the pre- and post-pubertal male that lead to differences in the complication rate and cosmetic outcome, he added. 

 

“Several studies have suggested that the use of a single relieving incision in boys is unfavorably associated with ‘dog ears' and is thus an unacceptable cosmetic result,” he said.  “We did not find this to be the case, although occasionally the base of the flap required trimming upon advancement to avoid this problem.”

 

Dr. Khan emphasized that appropriate preoperative counseling about ED should be routine before preputioplasty. Additionally, written instructions about postoperative foreskin retraction can help avoid dissatisfaction. “Such measures have been incorporated into our current practice,” he said.

 

With a low rate of complications and a high rate of patient satisfaction and 90% of patients requiring no further treatment, Y-V preputioplasty can be used in place of circumcision in men who have phimosis who wish to preserve their foreskin, he said. The procedure is associated with minimal or no scarring.

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