Adult circumcision : Are there any alternative treatments for tight foreskin in adults?

Phimosis or tight foreskin:  Are there any alternative treatments to circumcision ?

Under some circumstances, other alternative treatments may be considered to keep your foreskin but adult circumcision remains the most common treatment option to relieve your symptoms of tight foreskin. Alternatives to a circumcision include:

• Frenuloplasty – this is an operation to cut and lengthen your frenulum, which is the small tag of skin on the underside of your penis, between your foreskin and the shaft of your penis. If the frenulum is short or torn, you may have problems pulling your foreskin back. Frenuloplasty may relieve the symptoms. 

• Dorsal slit – in this procedure the foreskin is cut on the top of the foreskin to widen and loosen it, so it can be pulled back more easily. Cosmetic result showed fish mouth like appearance. 

• Prepuceplasty – this is a plastic operation called V-Y plasty or Z- plasty. This  procedure is more complicated than a circumcision. The foreskin is cut and stitched to widen it. This is not indicated in case of balanitis xerotica obliterans ( BXO). 

  Mr. Khan  can explain these treatments if they are suitable for you.

ADEQUATE PERI-OPERATIVE MANAGEMENT DECREASES COSMETIC COMPLICATIONS AFTER CIRCUMCISION WITH DISPOSABLE RING IN CHILDREN

Dr. Khan will present our results in his poster presentation at Barcelona, Spain on ESPU Meeting on Friday 21, April 2017. 

"We reviewed our experience in treating children with cosmetic complications following non-therapeutic male circumcision (NMC) with Plastibell and Circumplast devices at a community clinics ( Thornhill Clinic, Luton, Leyton Clinic, Leyton and Croydon London Clinic). This study highlights the factors leading to these complications and clinical management to improve the cosmetic appearance

A retrospective review of 3360 children who underwent Circumplast (CC) and Plastibell circumcision (PC) under local anaesthesia at the community clinics from May 2014 to October 2016. "

Ideal age of circumcision in children

Our audit at Thornhill Circumcision Centre, Luton, Bedforshire

incidence of complications in circumcision for 6 months olds is significantly lower when compared to 6 to 110 months old children.  We can conclude that under 6 months is the optimal age for non-therapeutic male circumcision in a community clinic using Circumplast and Plastibell devices.

Why biopsy is important in adult with balanitis xerotica obliteranes (BXO) or lichen sclerosis foreskin in phimosis (tight foreskin)

There are some association of skin cancer with BXO. In one of the series, incidence of skin cancer is reported 5.8%.  

In other series, incidence of BXO found adjacent to penile skin cancer is 33%. These findings raised a question whether BXO is pre-malignant condition. 

It is important to do biopsy of all BXO or lichen sclerosis foreskin to confirm the diagnosis and to rule out the concomitant skin cancer. Dr. Khan sends all foreskin with BXO for biopsy after the circumcision. 

Circumcision is strongly indicated if your foreskin shows signs and symptoms of BXO or lichen sclerosis which is causing tight foreskin. 

The British Association of Dermatologists has issued a guideline about MALE GENITAL (PENIS) LICHEN SCLEROSUS