Phimosis and Circumcision

What is Phimosis?

Phimosis is tight foreskin leading to the inability to pull the foreskin over the glans penis. It can present during childhood or adulthood.

What are the side effects or consequences of phimosis if untreated?

Untreated phimosis can lead to:

• Accumulation of secretions leading to recurrent infections of foreskin (balanoposthitis /balanitis/ posthitis)
• Recurrent urinary tract infections
• Retention of urine in extreme cases due to complete blockage of urinary meatus
• Difficulty in sexual intercourse
• Transfer of infections to partner/wife

Will phimosis go away in children?

Many children have physiological phimosis which usually gets resolved by 5-7 years of age without any intervention. If the physiological phimosis doesn’t interfere with urinary passage or doesn’t cause infections, then the child may be observed up to 5-7 years of age without circumcision surgery.

What is circumcision?

Circumcision is a very common surgical procedure carried out to remove the prepuce (tip of penile skin). Circumcision is done for phimosis (any religion) and for religious purpose (Muslims, Jews).

Is circumcision a daycare procedure?

Yes, circumcision is a daycare procedure. Usually, it takes around 15-45 minutes depending on the seriousness of the phimosis and the method used to do the circumcision.

What are the various methods of circumcision?

There are broadly three types of circumcision:

• conventional circumcision
• stapler circumcision
• laser circumcision

Conventional circumcision is a traditional way of doing the circumcision where the right foreskin is cut using a surgical knife (scalpel) and sutures (stitches) are put for approximation of cut edges. The stitches need not be removed as these are absorbable stitches. It is the safest and is the treatment of choice in complicated phimosis (associated with pus).

Laser is used instead of surgical knife in Laser circumcision which has no additional benefit in any factor.

Stapler circumcision is done using specialized anastomat stapler device. The procedure is quick, less painful, causes less bleeding and cosmetically better. The staplers usually fall off on its own by 2 weeks. Stapler retention even at 2-3 weeks is a disadvantage which can be addressed by manually removing the residual staplers.

What are the precautions after circumcision surgery?

There is no need for bedrest after surgery. The person can resume most of his routine activities from the very next day after surgery. He can drive a car home the same day but may not be preferable to ride a bike the same day. It is advised to not have intercourse for the first 15 days after surgery.