Name of the Procedure:

Foreskin Manipulation Including Lysis of Preputial Adhesions and Stretching

Summary

Foreskin manipulation is a medical procedure that involves the gentle stretching of the foreskin and the breaking down (lysis) of adhesions that may have formed between the foreskin and the glans (head) of the penis. This procedure is typically performed to address issues with foreskin retractability and is generally minimally invasive.

Purpose

This procedure aims to improve the mobility of the foreskin, allowing it to retract more easily over the glans. It addresses conditions like phimosis (tight foreskin that cannot be pulled back) and balanitis (inflammation of the foreskin and glans). The goal is to reduce discomfort, prevent infection, and improve hygiene.

Indications

• Phimosis
• Recurrent balanitis
• Difficulty with foreskin retraction
• Adolescents and adults with non-retractable foreskin
• Patients who prefer conservative management over surgical procedures like circumcision

Preparation

• Maintain general hygiene but avoid overly aggressive cleaning.
• Follow any specific instructions from a healthcare provider, such as applying a topical steroid cream if prescribed.
• No special fasting or medication adjustments are typically required.

Procedure Description

1. Initial Assessment: Examination of the foreskin and glans to determine the extent of adhesions and tightness.
2. Application of Anesthesia: Local anesthesia may be applied to minimize discomfort.
3. Adhesion Lysis: Using gentle manual manipulation, the healthcare provider will separate any adhesions between the foreskin and glans.
4. Foreskin Stretching: The foreskin is gradually stretched to increase its elasticity. This might be done manually or with specialized instruments.
5. Post-Procedure Care: Application of an emollient or prescribed ointment to promote healing.

Tools and Equipment

• Sterile gloves
• Lubrication gel
• Topical anesthetic
• Small blunt instruments (for gentle separation)

Anesthesia

• Local topical anesthetic

Duration

The procedure typically takes around 15 to 30 minutes.

Setting

Outpatient clinic or hospital setting.

Personnel

• General practitioner or urologist
• Nurse or medical assistant

Risks and Complications

• Mild discomfort or pain
• Minor bleeding
• Rare risk of infection
• Temporary swelling or redness
• Scar tissue formation

Benefits

• Improved foreskin retractability
• Reduced risk of infection and inflammation
• Enhanced personal hygiene
• Non-invasive alternative to circumcision

Recovery

• Mild soreness for a few days; over-the-counter pain relievers may be recommended.
• Maintain good hygiene and apply any prescribed ointments.
• Avoid vigorous physical activity for a short period.
• Follow-up appointment to monitor healing and effectiveness.

Alternatives

• Topical steroid creams: Non-invasive and can be effective but may require prolonged use.
• Circumcision: A more permanent solution but involves surgical removal of the foreskin.
• Preputioplasty: Surgical procedure to enlarge the foreskin opening without full removal.

Patient Experience

Patients might feel slight discomfort during and after the procedure, which is generally well-tolerated. Topical anesthesia helps minimize pain. Post-procedure, there may be minor swelling, but overall, the experience is relatively straightforward, with quick recovery and instructions to manage any discomfort or complications.