Save the foreskin: Outcomes of preputioplasty in the treatment of childhood phimosis

Symptomatic phimosis is a common childhood urology complaint. Circumcision was traditionally the treatment of choice, but its popularity in cases of non-scarred phimosis has been superseded by more conservative methods like preputioplasty. We sought to examine outcomes of preputioplasty for the treatment of non-scarred pathological phimosis in two UK paediatric surgery tertiary centres. Retrospective case series selecting cases performed in both departments over a 4 year period (January 2012–December 2015). Inclusion criteria: non-scarred pathological phimosis treated with preputioplasty. Exclusion criteria: diffuse scarring of foreskin or presence of balanitis xerotica obliterans (BXO), preputioplasty performed as part of hypospadias repair. Outcome measure was treatment success as evidenced by fully retractile prepuce at follow up. Follow up occurred between 3 and 24 months. We identified 126 patients, 6 were excluded due to the above criteria. Median age was 13.4 years (range 10 months–18 years). Median follow up was 13 months (range 3–24 months). 115 patients (96%) had successful treatment as evidenced by satisfactory post-operative cosmesis and complete resolution of phimosis at follow up. Recurrence of phimosis occurred in 5 patients (4%). Mean time of recurrence was 6 months, with a median age of recurrence of 15.3 years (range 10.7–16.7 years). All patients with recurrence were successfully treated with circumcision. Foreskin conserving methods like preputioplasty are a valid option in the treatment of non-scarred pathological phimosis.