Prepuce sparing: Use of Z-plasty for treatment of phimosis and scarred foreskin.

Publisher: Elsevier Country of Publication: England NLM ID: 101233150 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4898 (Electronic) Linking ISSN: 14775131 NLM ISO Abbreviation: J Pediatr Urol Subsets: MEDLINE

Original Publication: Kidlington, Oxford, UK : Elsevier, c2005-

Cicatrix/*surgery ; Foreskin/*surgery ; Organ Sparing Treatments/*methods ; Penile Diseases/*surgery ; Phimosis/*surgery; Child ; Child, Preschool ; Humans ; Male ; Severity of Illness Index ; Urologic Surgical Procedures, Male/methods

Introduction and Objectives: The desire to preserve the prepuce is often based on cultural norms. Recently, the concept of "genital autonomy" has been invoked to delay circumcision (or any genital altering procedure) until the individual reaches maturity and can make his or her own decision. However, some uncircumcised boys develop one or more episodes of balanitis resulting in scarring of the prepuce and pathologic phimosis which is difficult to treat. Herein we report on the management of severe phimosis and preputial scarring using preputial Z-plasties.
Materials and Methods: We reviewed the records of 28 patients, aged 3-12 years who underwent prepuce-sparing surgery within the previous 5 years with a minimum follow-up of 6 months. All patients were uncircumcised, with severe phimosis defined as a tight, pinpoint opening. All patients failed to respond to 6-10 weeks of betamethasone treatment. All parents requested preservation of as much of the foreskin as possible.
Results: All patients healed satisfactorily, without infection, hematoma, or flap necrosis. One child developed mild scarring which responded to local steroid application. At follow-up evaluation, ranging from 6 to 24 months, the prepuce was fully retractable in all patients (Fig.).
Conclusions: Excision of the scarred preputial ring results in a circular suture line, which is in essence a straight line, curved and connected at each end, and this is likely to contract over time. The principle of Z-plasty can be exploited to elongate and interrupt the straight line, preventing contracture thus widening and sparing the prepuce.
(Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Keywords: Circumcision; Phimosis; Preputioplasty; Z-plasty

Date Created: 20180618 Date Completed: 20191010 Latest Revision: 20191010

20240829

10.1016/j.jpurol.2018.04.031

29909192