Preputioplasty

Mr Barber and his colleagues describe parents' evaluations of preputioplasty (September 2003, JRSM¹). We are concerned that in 40% of the children the main indication was asymptomatic phimosis without a history of either recurrent balanoposthitis or voiding dysfunction. In our opinion this group of patients do not require surgical intervention and can safely be reassured and discharged. Our own surgical preference in the management of symptomatic patients is lateral preputioplasty. This procedure involves two laterally placed vertical incisions over the stenotic preputial bands which are subsequently closed horizontally.² It provides excellent symptom relief and avoids the unsightly cleft left by a single dorsal incision over a stenotic preputial band. Barber et al. had a rather poor success rate in preventing recurrent balanoposthitis. We think that a severely scarred foreskin is best managed by circumcision.³