Australian and New Zealand Journal of Surgery, Volume 59: Page 963, December 1989.
H. P. DUNN1
Auckland, New Zealand
Management of phimosis without operation is a possible alternative option for balanitis problems in certain circumstances.
Keywords: balanitis, phimosis
It is not generally known that, in the management of phimosis, there is an alternative to circumcision. This knowledge can be useful in circumstances where for various reasons operation is inappropriate or unavailable.
The patient was a 22 year old man in a Royal New Zealand Navy cruiser during World War II. He complained of penile pain and discharge and wondered if he had accidentally contracted venereal disease, but in fact he had not been exposed to this risk.
Examination showed that his problem was one of phimosis with recurrent balanitis. The diameter of the orifice in the prepuce was only about 0.5 cm. As we were at sea, frequently in action against the Japanese, and because at that time no one was able to get ashore for 3 months on end, there was no possibility of performing any non-urgent operation.
As an alternative management was therefore tried, based on the observation that the plastic capability of skin is unlimited. This has been demonstrated by the lower lip deformity gradually introduced by some primitive tribes, and also by the ear lobe elongation produced by heavy earrings.
The patient reported to the Sick Bay daily and for 2-3 min. the preputial orifice was put on stretch with a small artery forceps. This was a painful procedure but not unbearable. For a week no obvious improvement was noted but then the resistance at the margin of the orifice was suddenly overcome and by the end of the second week its diameter had increased to about 2.5 cm.
For the first time the prepuce was able to be retracted. With daily washing the balanitis soon cleared up. When the patient was followed up 6 months later, the anatomy appeared to be quite normal and there was no recurrence of phimosis or balanitis. The orifice was so slack that there was no risk of paraphimosis.
Although it cannot be claimed that this was one of the most notable advances in naval medicine or that it contributed significantly to ultimate victory, it was nevertheless a matter of considerable satisfaction to the patient.
With the modern decline in infant circumcision, phimosis problems will be seen more frequently. Adult circumcision may sometimes be avoided by this simple technique.
The teleological purpose of the prepuce remains a debatable area. Do we really know better than nature when we amputate so cavalierly?
1 FRCS, FRCOG, FRNZCOG; formerly Surg. Lt. Cdr. RNZNVR, formerly obstetrician and gynecologists, National Women's Hospital, Auckland, New Zealand.
Correspondence: H. P. Dunn FRCS, FRCOG, FRACS, HRNCZCOG, 168 Upland Road, Auckland 5, New Zealand.
Accepted for publication 12 July 1989.
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