May be caused by chronic or recurrent low grade
infection (candida) aggravated by attempts to retract foreskin
causing minor epithelial tears.
A condition of acute inflammation of glans penis
and foreskin. Caused by candia or faecal bacterial infection
most commonly in children
A dyskeratotic disorder of prepuce, glans penis
and urethral meatus. Hyperkaratosis, fibrosis and atrophy in
dermis and epidermis causing white stenosing bands which
haemorrhage in response to minor trauma. May lead to Phimosis,
adhesion to glans and and meatal stenosis. BXO is not a
Forskin is retracted and a tight restriction
develops around the subcornal region either due to tight
forekin or preputial oedema. Oedema and engorgement of glans
exacerbates the difficulty of reduction.
indications for circumcision
Medical: Phimosis, paraphimosis, recurrent
balanitis, BXO, in situ carcinoma or carcinoma or penis.
do you reduce
I start with a local anaesthetic penile block.
10ml of 1% lignocaine infiltrated just under skin
of pubic symphysis
Use lignocaine gel as a lubricant.
Squeeze the glans to reduce the oedema. Apply
progressive pressure for 10 minutes and this will allow the
foreskin to be protracted. Use fingers and thumb to return the
forekin to the normal position.
If this Is not successful, under GA, I attempt
manual reduction. If this does not work I perform a dorsal
slit to incise the tight constricting ring and allow
reduction. Great care is taken to avoid incising the urethra
when performing a dorsal slit. Circumcision follows at a later
do you perform
Supine. IV ABx.
retract foreskin and clean any material underneath. Sterile prep
Mark on the skin of penis the amount of skin to
Grasp the tip of foreskin with arteries and
retract forekin and dunk the galns in betadine solution if it
was not possible to prep.
It is usually possible to retract foreskin just
by stretching it with an artery. If impossible to retract
forekin then perform a dorsal slit using scissors, taking
great care not to incise the urethral meatus.
I incise the skin on the outside of foreskin
using a scalpel along the previously marked line
I retract the foreskin and incise the mucosa
about 3-5mm from the edge of the corona.
The dorsal veins need to be tied with 3/0 vicryl
I hold up the foreskin with artery and using
scalpel and divide the loose areolar tissue any substantial
vessels are tied with 3/0 Vicryl and smaller vessels are
coagulated with bipolar.
When I reach the frenulum, I encircle the frenula
artery with a U stitch of 3/0 Undyed vicryl.
I remove the foreskin and complete haemostais
with bipolar diathermy
I align the skin and the penis and suture the
skin to mucosa using interrupted 3/0 undyed Vicryl placing
stay sutures initially at 4 points of the compass.
I cover the suture line with paraffin gel.
I cut a hole in a combine pad and pass the penis
through the hole. I then fold the combine pad over the penis
to form a sporran dressing.