Name of the Procedure:

Slitting of prepuce, dorsal or lateral (separate procedure); except newborn

Summary

In simpler terms, this procedure is a surgical intervention where a slit is made in the foreskin (prepuce) of the penis. The slit can be made either on the top (dorsal) or the sides (lateral). This is not performed on newborns but on older children or adults who need it for medical reasons.

Purpose

This procedure addresses medical conditions like phimosis (tight foreskin that cannot be pulled back over the head of the penis). The goal is to relieve tightness and improve functionality, thereby alleviating discomfort or infections that can occur when the foreskin is too tight.

Indications

• Phimosis in older children or adults
• Recurrent infections under the foreskin (balanitis)
• Difficulty with urination due to tight foreskin
• Painful erections caused by foreskin constriction

Preparation

• The patient may need to fast for a few hours before the procedure if general anesthesia is used.
• Adjustments to medications (such as blood thinners) might be required.
• Pre-procedure assessments could include a physical examination and possibly some blood tests.

Procedure Description

1. The patient will be placed in a comfortable position, usually lying down.
2. Anesthesia will be administered—either local anesthesia to numb the area or general anesthesia, depending on the specifics of the case.
3. The surgeon will clean and sterilize the area around the foreskin.
4. A slit is made in the foreskin, either along the top (dorsal) or the sides (lateral).
5. The cut is carefully controlled to avoid damage to underlying tissues, particularly the glans (head of the penis).
6. Once the slit is made and the foreskin is repositioned to its intended position, the incision may be closed with absorbable sutures or left to heal naturally, depending on the technique used.

Duration

The procedure typically lasts between 15 to 30 minutes.

Setting

This procedure is usually performed in an outpatient clinic, surgical center, or hospital setting.

Personnel

• A urologist or general surgeon will perform the operation.
• A nurse or surgical assistant will help with the procedure.
• An anesthesiologist may be involved if general anesthesia is used.

Risks and Complications

• Infection at the site of the incision
• Bleeding or hematoma (accumulation of blood)
• Pain during recovery
• Unfavorable cosmetic outcome
• Rarely, injury to the glans of the penis or scarring

Benefits

• Relief from pain or discomfort due to a tight foreskin
• Improved hygiene and reduced risk of infections
• Enhanced ability to urinate without discomfort
• Improved sexual function

Recovery

• Detailed post-procedure care will involve keeping the area clean and dry.
• Pain management may include prescribed analgesics.
• Patients are usually advised to avoid sexual activity and vigorous physical activities for a few weeks.
• Follow-up appointments are scheduled to ensure proper healing.

Alternatives

• Topical steroid creams to treat phimosis
• Complete circumcision (removal of the foreskin)
• Preputioplasty, another surgical technique to widen the foreskin
• Each alternative has its pros and cons, ranging from non-invasiveness with creams to more definitive but invasive circumcision.

Patient Experience

During the procedure, the patient will be numb if local anesthesia is used or asleep if under general anesthesia. After the surgery, there might be pain or discomfort, easily managed with pain relief medications. Slight swelling and minor bleeding are normal but usually resolve in a few days. Proper care and following post-operative instructions can significantly help in a smooth and speedy recovery.