Redundant Foreskin After Circumcision

Why is a Circumcision Revision Necessary?

If the circumcised penis is healing correctly, the male patient will experience redness and tenderness around the incision area and the scab will fall off within 7-10 days. A few drops of blood is normal during the healing process as well. 

After circumcision, if the patient is experiencing an infection, or redness spreading up the shaft of the penis, more than a few drops of blood from the incision area, or is unable to pass urine over the period of 8 hours, a circumcision revision may be necessary.

The most prevalent reason for a circumcision revision is redundant foreskin. 

What Does a Second Circumcision Involve?

This type of revision is normally done by a urologist and he/she will be able to decide which type of revision is best. The sleeve surgical technique (foreskin is removed from its pulled-back position) is normally used for patients with redundant foreskin or a concealed penis. 

The surgery is individualized depending on the main presenting issue that’s arisen from the original circumcision. The surgery is generally done under local anesthesia. Competent practitioners will skillfully conceal all incisions, even tracing the lines of past procedure to minimize scarring. 

Indications that a Circumcision Revision May be Required?

What are some of the reasons a circumcision revision may be necessary to achieve satisfactory results?

•        Most common reason?

The most common reason a circumcision revision is required is the existence of redundant foreskin. This occurs when too much foreskin is left behind during the initial circumcision and is either partially or completely covering the glans of the penis when the penis not erect. 

•        Incomplete circumcision?

               Incomplete circumcision occurs when the amount of foreskin cut was either cut unevenly or not enough was cut. The practitioner may not have snipped enough                 or was wary of cutting too close. This is a result of insufficient practitioner experience. This is why it’s beneficial to meet with your doctor in advance of the surgery and to choose a competent surgeon. 

•        Practitioner inexperience?

Practitioner inexperience contributes to the need for a circumcision revision. The procedure is relatively simple and straightforward. However it does require some skill and precision to achieve the best outcomes.

•        Too much foreskin has been left behind?

Redundant foreskin after circumcision, or having too much foreskin left behind, partially or completely covering the glans or head of the penis when the penis is not erect, can be problematic. Having too much foreskin can lead to inflammation, infection, and an unpleasant cosmetic appearance. 

•        Not enough foreskin removed?

       Additionally, not enough foreskin having been removed results in redundant foreskin. It’s also considered an outcome of an incomplete circumcision. 

•        Inflammation, infection, and a poor cosmetic appearance?

       Having too much foreskin can lead to inflammation, infection and a poor cosmetic appearance. 

How is Circumcision Revision Done?

There are various techniques used on a circumcision revision procedure. In newborns, the most common circumcision revision techniques used are the following:

• The Dorsal Slit Technique – The Dorsal Slit method requires crushing and division of the inner and the outer preputial layers of the skin. The slit is extended to the corona. This enables the prepuce to be freed completely and excised, under direct vision.  

• The ZSR Technique – With this modern technique of circumcision, a stapler like device is used to cut and seal the edges of the skin. Only small incisions are needed and it’s a low pain procedure for the patient. This method also ensures minimal blood loss.

• The Plastibell Technique – This method is used for male babies in Malaysia. After being separated with a probe, a plastic bell fits over the head of the penis. Then, a piece of suture is tied directly around the foreskin which subsequently cuts off the blood supply.  A scalpel may be used to cut off the extra foreskin but the plastic ring is kept on. The plastic ring falls off on its own about 6-12 days after the procedure.

What Care is Needed After the Circumcision Revision?

After the circumcision revision, the practitioner will apply petroleum ointment over the wound and wrap the patient’s penis in gauze. This is necessary to keep the wound from sticking to the diaper on a male baby. 

You may see a little bit of blood oozing from the incision or on the diaper when the dressing is first removed. However, this generally will stop on its own. When bathing your baby, be gentle, as the penis will be sore for a few days after the procedure. Don’t use strong bath products. Many doctors recommend keeping the area as clean as possible. Use warm soapy water to gently wipe away anything on the penis. 

New dressing and petroleum jelly should be applied when the diaper is changed for the first few days post-surgery. Applying the petroleum jelly for up to 7 days after the procedure will help with rubbing and sticking to the diaper. Healing generally takes 7 to 10 days in totality. 

Circumcision Revision for Infants

Because local anesthesia is used for removal of redundant foreskin, many babies sleep right through the procedure without interruption. Some doctors even provide pacifiers if needed. Usually, parents are welcome to stay with their child if they choose. 

Circumcision Revision for Boys and Men

It is recommended that the circumcision revision be done as soon as possible after the original circumcision. Sometimes, this isn’t possible for one reason or another. Therefore, boys and men later in life choose to have a circumcision revision procedure done. 

Most doctors are equipped to handle this procedure at any age, whether the concerns from the original circumcision are cosmetic or medical.