PREPUTIOPLASTY


​Unlike circumcision, preputioplasty preserves the protecting, lubricating and sensory roles performed by the foreskin. Instead of amputating the phimotic ring or frenar band, what it does is to enlarge its opening.
The basic technique is illustrated above. After being anesthetized, the foreskin is retracted so that the phimotic ring squeezes the penile body behind the glans (ii). In this configuration, one or more small longitudinal cuts are performed, opened with a forceps, and then stitched transversely (iii). This procedure widens the diameter of the phimotic ring (iv) and allows the free movement of the glans[1]. It also slightly shortens the length of the foreskin, since it is this decrease in length that permits the increase of the perimeter of the phimotic ring.
In the diagram above, for simplicity, was illustrated the suture of only one incision. But two or more inline cuts may also be executed, for a better final aesthetic result (more incisions tend to smooth out the V-shape indentation at the foreskin opening that is characteristic of this procedure). Alternatively, there may also be executed many small cuts around the penile circumference, so that the deformity is distributed and less evident[2].
When the phimotic ring doesn't need to be widened too much, however, a well-executed single incision may present acceptable results, such as the following example[3]:
A controversial aspect of preputioplasty is indeed the aesthetical one, for which reason more sophisticated versions of the procedure described above (longitudinal incisions stitched transversally) may also be employed. However, these variations, such as Z-plasty and Y-plasty, involve a higher degree of difficulty, and may present higher complication rates.

REFERENCES

  1. Cuckow PM, Rix G, Mouriquand PDE (1994). Preputial plasty: a good alternative to circumcision. J. of Pediatric Surgery, 29(4):561-3.
  2. Wahlin N (1992). "Triple incision plasty". A convenient procedure for preputial relief. Scandinavian J of Urology, 26(2):107-10.​
  3. https://preputioplasty.wordpress.com/