Circumcision revision: correcting circumcision problems

Purpose of the operation

After circumcision, sometimes too little or too much skin is removed, the cut edge heals onto the head of the penis, the urinary opening narrows, or a scar pulls the penis inward. A revision restores the normal appearance and function of the penis and resolves hygiene problems and inflammation.

Not every unusual appearance is a mistake. In the first weeks after circumcision, swelling and a yellowish coating are part of normal healing.

Which problems are fixed, and how?

• Too little skin removed. If the skin covers the head of the penis again, causes inflammation or worries an older boy, the extra skin is removed with a revision circumcision. In babies there is no rush: as the fat pad shrinks, the appearance often corrects itself.
• Skin bridges and dense adhesions. Places where the cut edge has healed onto the head of the penis are divided and the edges are stitched. Thin adhesions often separate on their own.
• Trapped penis. A scar along the cut pulls the penis inward and squeezes it like a ring. In mild cases an ointment is tried first. Otherwise the scar is removed and the skin cover is rebuilt (buried penis repair).
• Meatal stenosis. The urinary opening is widened (meatoplasty).
• Inclusion cysts. Small white cysts along the cut are removed.
• Too much skin removed. Small skin loss usually heals on its own. With larger loss, or tightness and pain during erections, skin reconstruction is planned.
• Urethral fistula and injury to the head of the penis. Rare but serious complications. Planned repair of a defect left by an earlier injury is done after the tissues heal, by an experienced pediatric urologist using the principles of hypospadias surgery. If the head of the penis has just been injured or cut off during circumcision, do not wait: seek emergency care immediately.

When is it done?

Revision is a planned operation. Usually the tissues are allowed to heal fully, because surgery on inflamed, swollen tissue gives poor results. For small bridges and cysts the wait is a few weeks; for a fistula or complex reconstruction it is usually several months. The exact timing is set after the examination.

If there is bleeding, inability to pee, a fresh injury to the head of the penis or a change in its color, seek urgent medical care right away.

How is it done?

• Most revisions are done under a short general anesthetic with local numbing of the penis (anesthesia in children).
• Small skin bridges can sometimes be divided under local anesthesia.
• The stitches dissolve. Most children go home the same day.
• Home care is the same as after a standard circumcision: swelling and a yellowish coating are normal in the first days, and the dressing and ointment are used as the doctor advises (care after surgery).

How can it be prevented?

The best revision is the one that is never needed. Before circumcision, a doctor should examine the child: in hypospadias, buried penis, webbed penis and penile curvature, a standard circumcision should not be done, because the foreskin may be needed for later reconstruction. Circumcision should be performed by an experienced surgeon under sterile conditions.