Phimosis Op
Clemens Gödel is a freelancer for the medical team.
More about the experts All content is checked by medical journalists.Phimosis surgery is the surgical treatment of a narrowing of the foreskin. The foreskin is usually completely or at least partially removed (circumcision). This phimosis operation is performed quite often. While it is not risk-free, in most cases it will work. Find out here about the various phimosis surgery techniques and their risks!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. N47
Phimosis surgery: general
Phimosis surgery is the surgical treatment of a narrowing of the foreskin. A circumcision is often performed, i.e. the foreskin is removed - either completely or partially.
Circumcision is one of the oldest known operations that was probably performed 3500 years ago. The WHO estimates that around a third of all men worldwide are circumcised. However, the proportion of circumcised people varies significantly from country to country and, above all, depending on religious affiliation. In many countries, circumcision is carried out for religious reasons.
In the sense of a phimosis operation, however, circumcision has a clear medical reason: to restore or enable impaired functions, especially urination, erection and ejaculation.
When should phimosis be operated?
From a medical point of view, phimosis surgery is considered if treatment with a cortisone ointment was unsuccessful. However, surgery is only performed if the phimosis really needs treatment. This is the case, for example, in the following situations:
- Urination disorders (e.g. bloating of the foreskin, pain)
- (frequent) inflammation (s) of the foreskin
- Paraphimosis
However, surgery may also be indicated for lichen sclerosus and scarring.
Acute inflammation must be treated before phimosis surgery. In the vast majority of cases, this is done with antibiotics.
The foreskin is usually not removed if there are malformations on the penis that the foreskin may be needed to correct.
Phimosis surgery: explanation of the process and risks
Patients and, in the case of children, also their parents, should be informed precisely about the procedure and risks of a phimosis operation. You have to agree to the procedure. It should by no means be underestimated with regard to its risks, although it is carried out very frequently and usually leads to success.
How does the phimosis surgery work?
The phimosis operation is performed under general anesthesia and with anesthesia of the local nerves of the penis. In adults, general anesthesia may not be necessary.
There are different techniques of phimosis surgery:
Complete circumcision (complete circumcision)
The foreskin is completely removed so that the glans is then completely exposed. To do this, the foreskin is first detached from the skin of the glans beneath it; a possibly too short foreskin ligament (frenulum) is cut (frenulotomy). The foreskin is then incised on the back of the penis and separated at the transition from the glans to the shaft of the penis. The inner and outer foreskins are then sutured.
Economical circumcision (subtotal circumcision)
In this form of phimosis surgery, the entire foreskin is not removed, but part of it is retained.
Extension plastic
Here, the foreskin opening is widened by making cuts at certain points that are sewn in a special way. In patients with lichen sclerosus, this form of phimosis surgery is not possible because of the high risk of relapse.
In some cases, a careful detachment of the foreskin from the underlying skin of the glans is sufficient. In this case, however, it is not a real foreskin constriction. Rather, the foreskin is wide enough in this case, but just not sufficiently detached from the skin of the glans.
What are the risks?
The main possible risks of phimosis surgery are scarring, secondary bleeding (in one to six percent of cases) and infections (rarely).
There is a particular risk of scarring in the case of incomplete circumcision and plastic enlargement - i.e. surgical interventions in which the foreskin is at least partially preserved. The scarring can lead to functional disorders and put the affected person under severe psychological stress.The scarring can also occur in the course of growth if the scarred foreskin does not grow with it. Secondary phimosis can then develop. This may make another phimosis operation necessary. With a complete removal of the foreskin, there is practically no risk.
A consequence of the phimosis surgery can also be the scarred narrowing of the urethral opening (meatal stenosis), especially in the case of lichen sclerosus. To prevent this, a cortisone ointment can be prescribed after the operation.
After a phimosis operation, the glans penis can swell. In addition, sensitivity disorders can arise in the sensitive glans. Their significance for later sex life is controversial.
Sometimes the cosmetic result of the phimosis surgery is not satisfactory. Follow-up operations may then be necessary.
What happens after the phimosis operation?
A check-up is recommended three to four months after the phimosis operation. In patients with lichen sclerosus, the postoperative check-up should be carried out after two to four weeks. As a rule, however, the lichen sclerosus heals four to six months after the phimosis operation (in the sense of a complete circumcision).
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