Preputioplasty or prepuce plasty, also known as limited dorsal slit with transverse closure, is a plastic surgical operation on the prepuce or foreskin of the penis to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a stenosis which either has not relaxed during childhood and adolescence or has re-narrowed after sexual maturity.
Preputioplasty is a treatment for phimosis in the alternative to circumcision and superincision or dorsal slit
* which is conservative, non-traumatic and less invasive and can be performed on an outpatient basis under local anaesthetic in a doctor’s office and
* has the advantage of healing very quickly with little or no significant cosmetic alteration to the appearance of the penis.
Methods of performing preputioplasty
Preputioplasty may be performed by Y-plasty or Z-plasty, techniques also used in reconstructive surgery to loosen constricting scar tissue following traumatic burns.
However, Y-plasty and Z-plasty require a degree of surgical sophistication that physicians in general practice may lack.
More commonly it simply consists of one or more very short longitudinal incisions which release the stenosis — the constricting ring of tissue — in the foreskin and are closed transversely: [|] is closed and sutured as [—].
In the alternative to suturing, “[h]aemostasis [has been successfully] performed [in children] with a heated probe using the flame of an alcohol lamp or with bipolar electrodiathermy.”
|Preputioplasty. Fig 1. Penis with tight phimotic ring making it difficult to retract the foreskin. Fig 2. Foreskin retracted under anaesthetic with the phimotic ring or stenosis constricting the shaft of the penis and creating a “waist.” Fig 3. Incision closed laterally. Fig 4. Penis with the loosened foreskin replaced over the glans.|
Only one incision is shown in Figure 3; if two or more such incisions are made this will prevent a V-shaped indentation at the opening of the foreskin when the penis is not erect.
The opening of the foreskin is now normally wide enough for the foreskin to be easily retracted. The foreskin is also slightly shorter (by half the length of the longitudinal incisions which are now closed transversely) because the widening of the phimotic ring takes up some foreskin length.
Comparison with dorsal slit
|Dorsal slit. Fig 1. Unretracted phimotic foreskin. Fig 2. Dorsal slit is made from opening of foreskin along the entire length of the glans penis. Fig 3. Dorsal slit is closed transversely around the penis leaving glans penis permanently exposed. Fig 4. Entire foreskin tissue is now gathered on underside of penis below glans.|
By contrast, the dorsal slit (sometimes referred to in anthropological literature as superincision) leaves the glans penis wholly exposed and the appearance of a circumcised penis from the dorsal aspect.
However, no tissue is removed. The entire tissue of the foreskin gathers after a dorsal slit on the underside of the shaft, and gives the appearance of a turkey neck from a lateral or anterior view or in erection.
Preputioplasty versus circumcision and dorsal slit
European physicians and surgeons have carried out preputioplasties for many years in a social environment in which circumcision is widely considered anomalous.
Preputioplasty is appropriate in the majority of cases of non-retractile foreskin
* which are not complicated by scarring caused by recurrent infection or tearing and
* where there are no personal, cultural or religious reasons mandating circumcision as the preferred manner of relieving a phimotic stenosis of the foreskin.