“Trident” preputial plasty for phimosis in childhood

Summary 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.