Revisions after unsatisfactory adult circumcisions

Circumcision is a commonly performed operation carried out even for religious, congenital and acquired purposes. Although it is considered as a simple operation, its unsatisfactory functional and cosmetic result may result a wish for surgical revision.

A total of 48 men who underwent circumcision between August 2005 and December 2008 were referred to our practices with dissatisfied results. Mean age was 27.4 years (15-51). The reasons for presentation were hypertrophic scar (n = 21, 44%), scar wrinkling (n = 13, 27%), incomplete circumcision (redundant foreskin) (n = 11, 23%) and paraphimosis (n = 3, 6%). All patients requested and underwent revision under local anaesthesia. Cases with scar wrinkling (n = 13) and hypertrophy (n = 21) were managed by scar excision, in cases of incomplete circumcisions (n = 11) and paraphimosis (n = 3), circumcision was completed by sleeve resection technique with simultaneous resection of the scar of the previous operation.

Forty-six patients (96%) had a good aesthetic and functional result after the first revision. Two patients (4%) were still unsatisfied and insisted on another revision session. Another two cases suffered complications in the form of partial wound gaping that healed with daily dressing without the need for secondary sutures. No other complications were met.

Adult circumcision is a delicate genital surgical procedure rather than a simple "any-one-can-do-it" intervention. Hypertrophic scar tissue formation, scar wrinkling and incomplete circumcision are the most frequent complications of an improper technique. Adequate foreskin removal, delicate atraumatic surgical technique and special suturing techniques are necessary to achieve optimal cosmetic and functional result.