Phimosis and Circumcision in Paris
Dr Adam Vardi - Urological Surgeon
Disorders of the foreskin
Phimosis and posthectomy in Paris
Phimosis and disorders of the foreskin are among the most frequent reasons for consultation in pediatric and adult urology. Although often perceived as a simple intervention, surgery of the foreskin (posthectomy or plasty) responds to precise medical indications and must be carried out according to rigorous standards to guarantee an optimal functional and aesthetic result.
Pathophysiology of phimosis: from physiological to pathological
Pediatric urology in Paris & Neuilly
At birth, almost all boys present a natural adherence between the glans and the foreskin. This phenomenon, called physiological phimosis, is normal and protects the urinary meatus during the first years of life. With growth, spontaneous erections and cellular desquamation (smegma), the foreskin softens and gradually separates from the glans.
We speak of pathological phimosis when the preputial ring remains narrow, fibrous, or non-elastic, preventing the complete retraction of the foreskin. In children, the diagnosis is often made after the age of 3 or 4 if retraction remains impossible. In adults, phimosis can appear in a secondary manner, often linked to repeated infections or to dermatological pathologies such as lichen sclerosis, which sclerose the tissues and make the foreskin skin brittle and painful.
Indications for surgery of the foreskin
Doctor Adam Vardi - Pediatric urology in Paris
The decision to operate is never systematic. It is taken after the failure of conservative treatments (the application of corticosteroid ointments aimed at softening the fibrous ring) or directly in the face of certain complications:
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Recurrent infections: Balanoposthitis (inflammation of the glans and foreskin) is favored by the inability to clean the balano-preputial sulcus correctly. The stagnation of secretions can cause bacterial or fungal proliferation.
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Voiding obstruction: In severe cases, phimosis hinders the evacuation of urine, causing the foreskin to swell during voiding (a phenomenon known as “ballooning”).
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Paraphimosis: This is a urological emergency. It occurs when the narrow foreskin is forcibly retracted behind the glans and can no longer be put back in place. The ring then constricts the base of the glans, blocking venous circulation and causing major oedema.
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Pain during sexual intercourse: In adolescents or adults, the narrowness of the foreskin can cause painful skin tears or a sensation of excessive tension during erection.
Posthectomy in Paris & Neuilly
Urological surgeon in Paris
Surgical techniques: posthectomy and plasty
The procedure is performed under general anesthesia in children and adults (often supplemented by a local anaesthesia for post-operative pain control).
Posthectomy (medical circumcision)
This is the reference technique in case of scarred phimosis or lichen. It consists of the complete or near-complete removal of the foreskin. The glans is then left permanently uncovered. Hemostasis is carefully performed to limit the risk of bleeding, and sutures are made with absorbable threads which spontaneously disappear in two to three weeks.
Foreskin plasty
In certain selected cases, particularly when the skin is healthy and the narrowing is highly localized, a widening plasty may be proposed. This technique allows the foreskin to be preserved while widening the diameter of its opening. It is, however, less commonly performed in case of sclerotic tissues, as the risk of recurrence of the narrowing is higher than for circumcision.
Frenuloplasty (treatment of short frenulum)
It sometimes happens that phimosis is associated with a frenulum that is too short. This fold of skin connecting the glans to the foreskin can tear during intercourse. The surgeon then performs a section-plasty of the frenulum to release the tension and prevent subsequent bleeding.
Course of the procedure and post-operative follow-up
The operation most often takes place as day surgery. The patient enters the clinic in the morning and leaves a few hours after the procedure.
The post-operative course is marked by oedema (swelling) of the glans and the remaining foreskin, as well as by increased sensitivity of the glans during the first days, the latter no longer being protected by the skin. Simple local care is prescribed: application of healing ointments, gentle disinfection with soapy water, and the wearing of loose clothing. Pain is well controlled with classic Step 1 analgesics.
In adults, a four-week period of sexual abstinence is essential to allow solid healing of the tissues and to avoid the disunion of the suture stitches during nocturnal erections.
Risks and benefits: a pragmatic view
From a medical point of view, circumcision for pathological reasons presents a definite benefit: resolution of pain, simplification of local hygiene and elimination of the risk of paraphimosis or penile cancer (the latter being correlated with chronic inflammation under a narrow foreskin).
The risks, although rare, are inherent to any surgery: post-operative hematoma, local infection or, more exceptionally, stenosis (narrowing) of the urinary meatus. Particular attention is paid to the scar’s aesthetic appearance, although the main objective remains functional.
In conclusion, the management of phimosis by Dr. Vardi is based on a rigorous clinical evaluation. The procedure is only proposed when the benefits for the health and comfort of the patient are clearly established, guaranteeing an ethical and safe medical approach.