張廷瑞、陳世亮、許智凱

台南市立醫院 泌尿科

Ting-Jui Chang, Shih-Liang Chen, Chih-Kai Hsu

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Background: Circumcision is one of the oldest surgical procedures and one of the most commonly performed in practice today. However, like any other surgery, does carry the risk of complications. Complication rates depend on multiple factors, including anatomic abnormalities, medical comorbidities, surgical technique, and patient age. Here we present a case of severe penile foreskin adhesion causing penile deformity after circumcision procedure.

Case Report: A 39 year old male patient who underwent circumcision procedure 20 years ago. He visited our OPD for a cosmetic problem of his penis that disturbed himself and his wife. On examination, the glans was completely obscured by the adhesive foreskin, it was inseparably confluent with the normal glans from the meatus aspect to the shaft skin proximally. He memorized that this condition was happened right after the post-operative wound infection due to circumcision. Under general anesthesia, foreskin on glans was removed to the corona sulcus. For cosmetic consideration and to released the tension during erection, two V-Y plasty was made in parallel on ventral side of prepuce for extending and frenulum reconstruction. The rest of skin edge was deeply sutured on tunica albuginea at the corona sulcus level for better shape of glans. Post surgical recovery well, and the final appearance is appreciated by the couples.

Discussion: The adverse events during and after the circumcision procedure varies widely across reports. During a five-year period at the Massachusetts General Hospital, 7.4% of all visits to a pediatric urologist were for circumcision complications. Another report show in boys up to age 15 in the United Kingdom, 1.5% experienced a complication. Penile skin bridges are an uncommon complication of circumcision. It often results from either inadequate lysis of natural adhesions prior to circumcision or from distal migration of the skin from a prominent suprapubic fat pad. The majority of adhesions should cure spontaneously as the penis grows, suprapubic fat recedes, and erections become more frequent and firmer. Lysis of preputial adhesions also can be performed by gently pushing away the adhesions from the glands of penis. During healing process, the circumferential incision can adhere to the glands and in some cases heal into an epithelialized skin bridge. If thin and transparent, they can be divided in OPD manner. In our case, extensive and thick adhesions require surgical intervention, and excellent outcome was achieved.