Prepucioplasty (foreskin meatoplasty)

What is a prepucioplasty?

Prepucioplasty is an operation that is done when the foreskin is:

• too tight and causing problems
• abnormal and unlikely to stretch by itself

It makes the foreskin opening larger so that the foreskin can go back easily.

Why is prepucioplasty done?

Nearly all foreskins start off too tight to pull back but nearly all will stretch and go back eventually.

Some children’s foreskins can stay too tight and sometimes can cause problems. These problems can include difficulty with urine stream or repeated infections of the foreskin.

Some normal foreskins develop a condition called balanitis xerotica obliterans (BXO). This is a condition where the foreskin becomes thickened and scarred and the opening narrows down.

Prepucioplasty is used to treat BXO or foreskins that are too tight and causing problems.

How is a foreskin that needs an operation diagnosed?

If the foreskin is still too tight and causing problems after puberty then an operation may be needed. An abnormal foreskin is easily diagnosed by examination.

Are there any alternatives?

If the foreskin is too tight but not causing many problems it is often best to leave it to stretch up by itself. Sometimes steroid creams can be used to help the foreskin to stretch. These may also be used for early BXO.

If an operation is needed, then an alternative is to remove the foreskin, with circumcision.

Is a prepucioplasty any better than a circumcision?

These operations are no better or worse than each other. In terms of discomfort or complications, both operations are about the same.

With the prepucioplasty the foreskin is kept and your child will be left with a foreskin that pulls back but it doesn’t look quite normal. There is a small risk of the opening narrowing down again. If your child has a prepucioplasty it is possible we may need to repeat the operation or perform a circumcision later if things to not go right first time.

With a circumcision the foreskin is removed, so it will look different, but there is no risk of the foreskin narrowing down again.

What happens before the operation?

Usually no preparation is needed. Sometimes, some creams may be given to stop inflammation progressing before the operation. As it will be sore following the operation, it is helpful to have paracetamol and ibuprofen at home.

How is prepucioplasty done?

2 or 3 cuts are made in the tight part of the foreskin allowing the opening to stretch up and the foreskin go back. These cuts are then stitched up around the penis making the foreskin wider. Dissolving stitches are used so no stitches need to come out later.

When the operation is done for BXO often the head of the penis cannot be seen through the foreskin. BXO can affect the glans and in particular the urethra. This is checked during the operation. Sometimes if the urethra has been narrowed by the BXO we need to make the opening a bit bigger by cutting it. In addition to this during the operation some steroids are injected into the foreskin to help the BXO to settle down. This causes a bit more swelling immediately after the operation.

Are there any risks with prepucioplasty?

Prepucioplasty is not a major operation and problems from it are not usually serious.

The foreskin will bruise and swell immediately after the operation and it may look swollen for a week or so afterwards. It can sometimes be a little sore to wee for the first few days.

The cuts can bleed or get infected in around 2 percent to 5 percent of case. If an infection happens, it will be 4 to 7 days.

The major risk is that the operation does not work and the foreskin becomes too tight again, this happens in around 10 percent of operations. Although the stitches used are dissolving sometimes bits of string appear from the skin. If this happens the ends can be trimmed with scissors or left to fall out by themselves.

What happens after the operation?

Your child will be able to go home the same day as the operation. Food and drink are usually allowed as soon as your child has woken up. The area will be sore for a couple of days but children are usually back to normal activity within a few days. Regular paracetamol and ibuprofen can help with this.

Your child can go back to swimming after a week and sports as soon as comfortable.

The cuts will scab over and need to be kept dry for the first couple of days.

If there is evidence of BXO on the head of the penis you may be given some cream to apply for a few weeks to help the BXO to settle down.

Does my child need to be seen after the operation?

Sometimes, if the operation is very straightforward you will not need to be seen again. If the doctor thinks that you have BXO it is important to see you again a few weeks later to make sure that the BXO is settling down.

Are there any long term effects following prepucioplasty?

In most cases it is clear within a couple of months if the operation has been successful. In these cases there should be no long term effects. In cases of BXO the condition can recur.