Foreskin Reconstruction
DEFINITION
Foreskin reconstruction is a procedure performed for a congenital abnormality of the foreskin, where the patient is born with foreskin that does not wrap completely around the head of the penis. This is most commonly seen in the setting of hypospadias (with or without curvature and/or a displaced urethral opening), but can also be an isolated finding.
GOALS OF CARE
The surgery closes the foreskin so that it wraps around and covers the head of the penis. The goal is to create a foreskin that looks as normal as possible, and can still be retracted to expose the head of the penis.
When the urethral opening is abnormally shaped, or displaced, then a foreskin reconstruction may serve the additional function of funnelling the urine during urination, and helping to control and direct the stream.
For patients born with very mild hypospadias (little to no bend, and a urethral opening which is displaced but still on the head of the penis), then a foreskin reconstruction is an excellent option, as it gives the patients penis a very normal appearance, and still leaves the patient with a full complement of reconstructive options in the future, if for any reason it was decided later in life that the foreskin reconstruction alone was not enough.
OUTCOMES
Foreskin reconstruction is a short simple and straightforward procedure.
There is a 1-2% risk of infection, which may affect the success rate, appearance and recovery.
Foreskin fistula (where the urine might leak between the stitches) occurs in 15% of cases, but can be corrected with minor surgery no sooner than 6 months later.
Phimosis (where the foreskin is too tight to be pulled back and expose the head of the penis) may happen up to 16% of the time, but can be treated effectively with steroid cream in the majority of cases, and revision surgery in very few.
Long term studies show that 95% of patients have an intact foreskin 20 years later.
OUR APPROACH
Dr Rob performs foreskin reconstruction with a three layered technique, which has been shown to have favourable outcomes versus other methods.
Surgical magnification and very fine sutures are used for the reconstruction.
A catheter is not required unless the urethra is also reconstructed as part of a hypospadias correction.
The skin is closed with a combination of sutures and medical glue.
POST OPERATIVE RECOVERY AND CARE
Foreskin reconstruction is a day case procedure. You will take your child home on the same day. The glue will flake off and the sutures will dissolve and vanish. You may bathe your child the very next day. It is common for there to be significant swelling that may last for weeks. If complications arise, it is most commonly an infection, which develops a few days after the surgery, or a fistula, which may not become obvious for weeks, months, or even years.
If a catheter is required to drain urine while the urethra is swollen, then you will be taught how to care for the catheter during the post operative recovery.