Circumcision for phimosis – laser and classic technique

Circumcision is the surgical removal of the foreskin (prepuce) – the fold of skin that covers the head of the penis (the glans). It is one of the most frequently performed operations in urology, and the most common medical reason for it is phimosis – a narrowing of the foreskin that prevents the glans from being uncovered freely.

Dr Penev performs circumcision using the classic surgical technique, and when the indications and the available equipment allow, the incision can also be made with a surgical laser. Which approach suits you better is decided at the consultation in Plovdiv, depending on your age, the condition of the tissues and the reason for the operation.

When it is recommended

Circumcision is considered when the foreskin causes a health problem, not just for cosmetic reasons. The most common indications are:

• phimosis in adults – pain or cracks during an erection, difficult hygiene, urine trapped under the foreskin;
• recurrent balanitis and balanoposthitis – inflammation of the glans and foreskin, especially in men with diabetes;
• lichen sclerosus – whitish, thickened scar-like changes on the foreskin, for which circumcision is the preferred treatment;
• a past episode of paraphimosis – a retracted foreskin getting stuck behind the glans;
• a short frenulum combined with phimosis – in this case circumcision can replace a separate frenulotomy.

For boys the situation is different. Phimosis in childhood is most often physiological: the foreskin is naturally stuck to the glans and separates gradually by school age or puberty. Surgery is considered only for scarred phimosis, ballooning of the foreskin with repeated urinary tract infections, or frequent inflammation, usually after an unsuccessful trial of corticosteroid cream. Parents can get a calm assessment from the paediatric urologist without rushing into a decision about surgery.

Paraphimosis is an emergency: if a retracted foreskin cannot be returned to its normal position and the glans becomes swollen and painful, go to an emergency department straight away or call 112 (the European emergency number) instead of waiting for a booked appointment.

How it is done

1. Consultation. Dr Penev examines the foreskin and the glans and assesses whether the operation is necessary and whether it should be full or partial, keeping part of the foreskin. The type of anaesthetic and the alternatives are discussed, for example a widening plastic procedure (preputioplasty) for mild phimosis.
2. Anaesthetic. In adults – most often a local anaesthetic at the base of the penis, combined with light sedation if you wish. In children – a short general anaesthetic so that the child stays calm and still.
3. Operation. The excess foreskin is removed, bleeding vessels are sealed and the skin edge is stitched with dissolvable stitches that fall out on their own. When a laser is used, it replaces the scalpel for the incision; the other steps are the same. The operation usually takes 30–45 minutes.
4. Dressing and discharge. A soft dressing is applied and, after a short period of observation, you go home the same day. If lichen sclerosus is suspected, the tissue removed is sent for histological examination.

Preparation

• Tell the doctor about all the medicines you take, especially blood thinners – Dr Penev will tell you whether and when to stop them.
• Any active inflammation of the glans is treated before the operation.
• For a general anaesthetic or sedation, follow the anaesthetist’s instructions on fasting, and you or your child should come with someone accompanying you.
• Have a shower on the morning of the operation; shaving is not necessary.
• Plan a few quiet days after the operation and have loose cotton underwear ready.

After the procedure

Swelling, slight bruising and soreness are normal for the first few days and are controlled with ordinary painkillers. The dressing is removed after 24–48 hours, and the stitches dissolve within two to three weeks. Keep the wound clean with water and, if needed, an antiseptic; you will receive detailed instructions when you are discharged.

Full healing usually takes 2–4 weeks. You can go back to work or school after a few days, sport is postponed for about a month, and sex can be resumed after the follow-up check, usually 4–6 weeks after the operation.

See a doctor without delay if there is bleeding that does not stop with pressure, pus, a high temperature or if you cannot pass urine.

Where it is done

The consultation and follow-up checks take place at Dr Penev’s urology practice in Plovdiv, 5 Anri Barbyus St, or at Vita Med Medical Centre in Karlovo. The operation itself is performed in an operating theatre setting – depending on the doctor’s assessment, either as an outpatient procedure or at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv; for children and under general anaesthetic it is always done in the hospital. The place and type of anaesthetic are confirmed at the consultation.

Price

An initial consultation costs €50 and a follow-up consultation €30. The price of the circumcision itself depends on the technique, the type of anaesthetic and where it is performed, and is confirmed when you book.

If phimosis or frequent inflammation is causing you problems, book an appointment with Dr Penev – you will get a clear assessment of whether circumcision is necessary and which approach is right for you.