Circumcision

Skin bridge and Preputial adhesion after circumcision

A penile skin bridge can occur in circumcised males after their childhood period. These bridges cause pain or discomfort and may require correction.

A penile skin bridge requires operative correction as it is a thick skin attachment from the shaft skin of the penis to the head of the penis (glans).  It causes pain and discomfort during Erection due to tethering of skin.  . These will not be resolved on their own and is actually more uncomfortable and bending of the penis with penile growth

What is a penile Skin Bridge?

When the incision heals improperly to the gland in a circumcised male, the shaft skin becomes permanently attached to the glans. The. penile skin bridge develops. 

Penile skin bridge can occur in childhood right after the infant circumcision. But adult may not realise it until he is sexually active and feels a pulling the head of the penis when he has sexual activities and erection. 

Operation for a Penile Skin Bridge 

  • A urologist usually carries out the procedure under a local anaesthetic.

  • Local anaesthetic nerve blocks also provide post-operative pain relief

  • He divides the skin on the top of the head of the penis and both skin edges.

  • He uses dissolvable stitches throughout which usually disappear within two to three weeks.

  • He applies and seals the wound with glue which sloughs off within 10 days.

  • we normally wrap the penis in a loose bandage which you can remove after 1-2 days.

  • Some patients may require a circumcision revision if the patient has more scarring with multiples skin bridges.

  • The underlying colour of the skin may different colour than the rest of the skin of the shaft and head of the penis.

What can I expect when I get home?

• You will get some swelling and bruising of the penis which may last several days

• All your stitches will disappear, usually within two to three weeks, but may sometimes take a little longer

• Simple painkillers such as paracetamol or Ibuprofen are helpful if you have any discomfort

• Any dressing should fall off within 24 hours; if it does not, or if it becomes soaked with urine, it should be removed

• Keep the area dry for 48 hours; avoid soaking in a bath

• You should not swim or any exercise for two weeks

• Try to keep your wound clean and dry after passing urine

• Apply a little Vaseline to the tip of your penis and around the stitch line to stop it from sticking to your clothing

• Wear tight-fitting clothing for two to three days

• You should retract your foreskin on a daily basis to maintain the benefits of the surgery after 3 days 

• You will be given a copy of the letter which should be given to your GP

• Any antibiotics or other cream, you need to get from any pharmacy

• You should refrain from sexual activity (intercourse and masturbation) for up to four to six weeks 

If you notice any re-attachment happening, please contact us for an assessment

What are the risks, consequences and final outcome?

Most operations are straightforward; however, as with any surgical procedure, there is some chance of side-effects or complications such as:

Bruising and swelling generally happen. Significant swelling of the bridge incision will develop during the first few days. This swelling may last for 2-3 weeks or longer.  bleeding from the wound site (occurs in 2 - 3% of patients) but is usually minimal and settles quickly. Infection can arise and is usually minor but can be possibly serious with an incidence of less common.  Tenderness of the scar at the wound. Dissatisfied with the cosmetic result. Failure to improve your symptoms may result in the need for full revision circumcision. 

Contact us for further consultation

Treatment of scared foreskin ( BXO phimosis)


TREATMENT FOR PATIENTS WITH PHIMOSIS DUE TO BXO IN OUR LONDON CLINIC  

1. Tight foreskin can be treated with steroid cream, circumcision or further operations   

2. Remote or face to face Consultation before the circumcision  

3. Glue circumcision is better than stitches

4. Aftercare advice will be given following the circumcision  

5. To send the biopsy £150 to confirm the diagnosis and exclude any malignancy 

6. Follow up after 6 weeks of circumcision to see if BXO is present at Glans and meatal opening  

7. Advice and treatment will be given at our clinic with our consultants

8. Long term follow up required if biopsy-proven BXO found after the circumcision  

Please contact us for specialist and professional opinion.

Consider consultation with Dr Khan  for the following reasons:

  • Therapeutic circumcision

  • Circumcision for symptomatic phimosis or paraphimosis

  • Significant narrowing or obstruction of the urethral meatus or changes in urinary flow

  • In some cases of male genital lichen sclerosus (BXO), painful erections may limit sexual function

  • A careful clinical examination, history of skin disease and recent tight foreskin (phimosis) give a diagnosis of balanitis xerotica obliterans with certainty

please call or text us on direct clinic number 07527 314081

Adult circumcision with CircCurer (LangHe) staple device (ZSR Circumcision)

First Private Clinic in London, UK, that Offers  Circumcision with this Novel CircCurer (LangHe) staples Device

Many patients are asking Dr Khan to circumcise with ZSR or stapler devices. Adult circumcision can be performed by  CircCurer (LangHe) or ZSR staples suture device. Dr Khan has simulation training in CircCurer (LangHe) staples suture device. 

Dr Khan offers circumcision with this new CircCurer (LangHe) staple device at The London Circumcision Clinic, Leyton, London. 

Adult circumcision with CircCurer stapler is a quick procedure. When it was compared with conventional circumcision with stitches, stapler circumcision is associated with shorter surgical time, higher patient satisfaction with penile looks, lower operative pain, less operative blood loss, and lower wound bleeding post-operatively. However, wound healing takes longer than traditional circumcision in adults.

 Anaesthesia

A local anaesthetic is used for the circumcision with staplers and injected into the base of the penis and all around the shaft of the penis. This provides safe and effective pain relief during the circumcision. This also minimises post-operative pain for a few hours.

Men's Circumcision Cost with CircCurer in the UK (16-YEAR-OLD AND ABOVE)

Circumcision with stapler Device £780 includes consultation on the same day and one free follow-up visit.

Informed Consent

We provide the patient with all the information about the stapler circumcision ahead of time. Stapler Circumcision is an irreversible procedure and makes the head of the penis exposed permanently. Informed consent is taken before the procedure.

Full or Partial Circumcision

Full circumcision means moderately cutting the inner and outer foreskin to expose the full of head of the penis. Partial circumcision leaves loose skin, which partially covers the glans (head of penis). Partial circumcision may not work in all adults. 

Full circumcision might give a false impression of loose/partial circumcision when the penis is in a flaccid state, especially in patients with a buried penis. Partial circumcision is possible, but it has a few complications in the long term. These can be discussed with Dr Khan at the Adult Circumcision Clinic  in London, UK

 Procedure Technique

The following are methods for adult and boys over 16-year-old for circumcision: 

  • After local anaesthesia, the foreskin was retracted, and assess the suitability.

  • If there is scarring due to BXO, stapler circumcision is not advisable to perform.

  • Apply the bell of the instrument inside the foreskin

  • Secure the right position of the stapling device

  • Cut the skin and staples applied at the same time

  • Apply the bandage around the wound at the end of the circumcision

Recovery for Adult Circumcision with staplers 

Circumcision with a stapler heals quicker than one with stitches. Swimming and weight lifting should be avoided for 2-3 weeks. Full recovery following circumcision generally requires 4-6 weeks.  Over-sensitivity of the glans may take a few months to resolve.

Adult Circumcision Healing Tips

To reduce the effect of night erections, pull on the staplers during the first few days after the adult circumcision, empty your bladder before retiring and a few times during the night. Sleep on your side or back. It may be helpful to draw your knees up a bit into a more foetal position. Wear tight underwear after the circumcision to prevent unnecessary movement. Follow the aftercare advice and keep the wound dry for five days. 

Please take vitamin C regularly for ten days to promote healing. If the staplers are completely off, apply vitamin E cream, Mederma gel, or bio-oil to the scar after 15 days. This will improve the scaring. Please contact us at The London Circumcision Centre for further advice.

Medical evidence 

Five recent studies involving 2026 men were included in comparing the stapler and conventional circumcisions with stitches.  The statistically significant incidence of circumcision with staplers was intra-operative blood loss, operating time, the mean pain score on the operation day, the mean pain scores on post-operation days and wound healing time. The majority of the patients (88.0%) required the removal of residual staples postoperatively after four weeks. 

References: 

  1. Brazilian Journal of Medical and Biological Research (2015) 48: 577-582

  2. Asian Journal of Andrology (2017) 19, 362–367

  3. Scientific Report (2016) 6, 25514 

Risk of Adult Circumcision

The risks of circumcisions are explained to the patients. Risks are failed staple procedure requiring traditional circumcision, bleeding, bruises, haematoma formation, infection, retaining of staplers for more than four weeks, unintentional damage to the glans, removal of too much or too little skin, lymphoedema, aesthetically displeasing results and a change of sensation during sexual activity.

The patient should also be informed that, during the postoperative period, erections can cause pain, bleeding and discomfort. There are slight chances of disruption of the staples or scarring of wounds, which might require a redo or revision circumcision. 

Postoperative Care

You might experience discomfort for a few days after the circumcision, but painkillers help to decrease the pain. Passing urine is not usually affected by the circumcision. There will be swelling and bruising of the shaft of the penis for 2 to 3 weeks after the stapler circumcision. This will then subside gradually and should not be a cause for alarm. Bleeding after circumcision can be stopped by applying pressure or a bandage.

A dressing (bandage) is applied around the wound line to prevent the wound from sticking to your underclothes. A bandage with self-adhesive stretch gauze will stay for three days (Cobain). The wound will be at least 2-3 weeks before healing is completed, and you may return to work when you are comfortable enough.

Most people require at least 2-3 days off work. You should gently wash the wound daily after one week if the wound is dry and shower regularly.  It would be best to stop going to the gym or lifting heavy weights for 2 weeks. You should avoid any sexual activity for 4-6 weeks after the circumcision to avoid the breakdown of the wound.

Follow up visit

 Some of the staplers come off themselves. However, some staples remain over the wound after 3 weeks. All patients require arranging an appointment after 3-4 weeks so that we can remove the residual staples. 

PS: This information is for suggestions only. It is not a substitute for professional medical advice. Please call Dr. Khan at +447527314081 for free telephone advice without any obligation.

 © London Circumcision Centre, 2024. Unauthorised use and duplication of this blog without express and written permission from this blog’s author and owner is strictly prohibited.

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