"Trident" preputial plasty for phimosis in childhood
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Published on: November 30, 2010
Pierluigi Pedersini1, Filippo Parolini1, Anna Lavinia Bulotta1
1Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy.
Insights
The modified-triple incision preputial plasty, or "trident" plasty, effectively treated phimosis in children, achieving excellent functional and cosmetic outcomes in 97.6% of cases within 12 months.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Phimosis is a common condition in children that can lead to recurrent infections and voiding difficulties.
- Conservative treatments like topical corticosteroids are often attempted first.
Purpose of the Study:
- To assess the efficacy and outcomes of the modified-triple incision preputial plasty for pediatric phimosis management.
- To evaluate both functional and cosmetic results of the surgical intervention.
Main Methods:
- A prospective study included 41 children (ages 3-15) with phimosis refractory to a two-month topical corticosteroid trial.
- The surgical technique involved a "trident" preputial plasty, combining Z-plasty and Y-V plasty.
- Procedures were performed as day care surgery under general anesthesia with follow-up at 1, 2 weeks, and 1, 6, 12 months.
Main Results:
- The study enrolled 41 patients, with a mean operative time of 24 minutes.
- At 12-month follow-up, 97.6% of patients achieved successful foreskin retraction.
- Both cosmetic and functional results were reported as satisfactory.
Conclusions:
- The "trident" preputial plasty is an effective surgical option for selected children with phimosis.
- Excellent cosmetic and functional results were observed, with successful foreskin retraction being a key indicator.
Objective:
To evaluate the functional and cosmetic result of modified-triple incision preputial plasty for surgical management of phimosis in children.
Materials And Methods:
This prospective study involved all consecutive children (age 3-15) with phimosis, managed at our Institution in a one-year period. All patients unable to retract the foreskin and symptomatic with episodes of posthitis or balanoposthitis or ballooning of the foreskin with voiding were initially included. After a two-month trial of topic corticosteroids treatment, for patients refractory to conservative ointment treatment, "trident" preputial plasty was offered. This procedure combines two lateral Z-plasty and one middle Y-V plasty. All the procedures were performed as a day care, in general anaesthesia by two senior surgeons. Outpatient follow-up controls were scheduled at 1 and 2 week, 1, 6 and 12 months after surgery, respectively.
Results:
A total of 41 patient were enrolled. Mean operative time was 24 minutes (range 15-43). At 12-month follow-up, all but one patients (97.6%) was able to retract the prepuce. Cosmetic and functional results were satisfactory.
Conclusion:
In selected group of children with phimosis, the "trident" preputial plasty provided excellent cosmetic and functional result. Adequate retraction of the prepuce by the patients soon after surgery is mandatory.
