Phimosis-Op

Phimosis-Op: General

A phimosis surgery is the surgical treatment of a foreskin constriction. Circumcision is often performed, that is, the foreskin is removed – either completely or partially.

Circumcision is one of the oldest known operations, presumably performed 3500 years ago. The WHO estimates that around one third of all men worldwide are circumcised. However, the proportion of circumcision varies considerably from country to country and, above all, depending on religious affiliation. In many countries circumcision is carried out for religious reasons.

On the other hand, in the sense of a phimosis-op, circumcision has a clear medical reason: the restoration or facilitation of impaired functions, especially urination, erection, and ejaculation.

When should a phimosis be operated on?

From a medical point of view, a phimosis-op is considered if treatment with a cortisone ointment was unsuccessful. But surgery is only done if the phimosis really needs treatment. This is the case in the following situations:

• Urination disorders (e.g., foreskin inflation, pain)
• (frequent) inflammation (s) of the foreskin
• paraphimosis

However, surgery may also be indicated for lichen sclerosus and scarring.

An acute inflammation must be treated before the phimosis-op. This happens in the vast majority of cases with antibiotics.

A removal of the foreskin is usually not carried out if there are malformations on the penis, for the correction of the foreskin could be needed.

Phimosis-Op: Clarification on the course and risks

Patients and in children also the parents should be informed exactly about the course and risks of a phimosis-Op. You have to agree to the procedure. It should by no means be underestimated in terms of its risks, although it is done very often and usually leads to success.

How does the phimosis-op work?

The phimosis-Op is performed under general anesthesia and on anesthesia of local nerves of the penis. In adults, it may be necessary to do without general anesthesia.

There are several techniques of a phimosis surgery:

Complete circumcision (complete circumcision)

The foreskin is completely removed, so that the glans is then completely exposed. First, the foreskin is detached from the underlying skin of the glans; a possibly too short foreskin band (frenulum) is severed (frenulotomy). At the back of the penis, the foreskin is then incised and severed at the transition from glans to penis shaft. The inner and outer foreskin are then sutured.

Economical circumcision (subtotal circumcision)

In this form of phimosis-Op not the whole foreskin is removed, but it remains a part.

extension plasty

Here, the foreskin opening is widened by cuts are made at certain points, which are sewn in a special way. In patients with lichen sclerosus, this form of phimosis-op is not possible because of the high risk of relapse.

In some cases, the careful solution of the foreskin is already sufficient for the underlying skin of the glans. But then it is not a real foreskin constriction. Rather, the foreskin is far enough in this case, but only insufficiently detached from the skin of the glans.

What are the risks?

Possible risks of phimosis-Op are mainly scarring, rebleeding (in one to six percent of cases) and infections (rare).

The risk of scarring is especially in incomplete circumcision and plastic surgery – that is, in surgical procedures in which the foreskin is at least partially preserved. Scarring can lead to functional disorders and put a heavy strain on those affected. The scarring can also occur in the context of growth, if the scarred foreskin does not grow along with it. Then a secondary phimosis can arise. This may require further phimosis surgery. With complete removal of the foreskin, this risk is virtually nonexistent.

A consequence of the Phimose Op can also be the scarred constriction of the urethral opening (meatal stenosis), especially in lichen sclerosus. To prevent this, a cortisone ointment may be prescribed after surgery.

After a phimosis-Op, the glans (glans penis) may swell. In addition, sensory disturbances can arise on the sensitive glans. Their importance for later sexual life is controversial.

Sometimes the cosmetic result of the phimosis-op is unsatisfactory. Then reoperations may be necessary.

What happens after the phimosis-op?

Three to four months after phimosis surgery, a follow-up visit is recommended. In patients with lichen sclerosus, the postoperative control should take place after two to four weeks. In general, however, lichen sclerosus heals four to six months after Phimosis-Op (in the sense of complete circumcision).