THE PREPUCE

Diseases of the penile foreskin include:

Male circumcision

The resection of the prepuce is the definitive surgical treatment. The purpose of the operation is to resect the prepuce obliquely at the level of the corona of the glans, allowing the glans to be fully exposed while preserving enough of the frenulum to permit erection.

Technique

1	Conduction anaesthesia can be used for circumcision. Dorsal nerve block is reinforced by infiltration of the underside of the penis between the corpus spongiosum and the corpora cavernosa.
2	Prepare all the external genitalia with an antiseptic. If the prepuce can be retracted, carefully clean the glans and the preputial furrow with soap and water. If the prepuce cannot be retracted, gently stretch the preputial opening by inserting the blades of a pair of artery forceps and slowly opening them until the area can be properly cleaned (Figure 9.27). Break down any fine adhesions between the glans and replace the prepuce. Isolate the penis with a perforated towel.
Figure 9.27
3	Take hold of the prepuce dorsally in the midline with pairs of forceps and cut down between the forceps with scissors until the blades nearly reach the corona (Figures 9.28, 9.29). Check that the lower blade really is lying between the glans and prepuce and has not been inadvertently passed up the external meatus. Then excise the prepuce by extending the dorsal slit obliquely around on either side to the frenulum, and trim the inner preputial layer, leaving at least 3 mm of mucosa (Figure 9.30).
Figure 9.28
Figure 9.29
Figure 9.30
4	Catch the cut edges of the frenulum and the bleeding artery of the frenulum with absorbable suture, leaving the suture long as a traction stitch to steady the penis (Figure 9.31). Insert a similar traction stitch to unite the edges of the prepuce dorsally (Figure 9.32). Catch and tie any bleeding vessels on either side of the raw area. Unite the edges of the prepuce with interrupted stitches and cut the stitches short (Figures 9.33, 9.34).
Figure 9.31
Figure 9.32
Figure 9.33
Figure 9.34