Treatment of a Hooded Foreskin

What are the options for treating a Hooded Foreskin?

There are 3 options:

1. To do nothing. 
2. To reconstruct the foreskin.
3. To perform a completion circumcision.

1.  Doing Nothing

As this condition is mainly a cosmetic defect, it is possible to do nothing about the hooded foreskin.  This will allow your son to make a decision regarding if he wants treatment for the hooded foreskin and what he wants done when he is older.  The downside is that if he decides that he wants surgery when he is older, the operation will take more out of him. 

2.   Foreskin Reconstruction

It is possible to reconstruct the foreskin in a boy with a hooded foreskin.  This is done as a daycare operation (meaning normally there is no overnight stay), under a full general anaesthetic.  The surgery takes about 45 minutes.  The surgery has risks which include:

• bleeding, 
• infection,
• the repair coming apart (this is called a dehiscence), 
• part of the repair not healing properly leading to a connection from the inside of the foreskin to the outside (this is called a fistula)
• Difficulty pulling back the foreskin when your son is older.
• Not liking the look of the penis after the foreskin reconstruction

If there are issues with a fistula or the repair comes apart then it is possible to either redo the repair of do a circumcision.

Reconstructing the foreskin means that the penis looks uncircumcised.  It also gives your son the opportunity to decide if they want to be circumcised or not later in life.

3.  Circumcision

Circumcision is the name of the operation to remove the foreskin. A circumcision in a boy with a hooded or incomplete foreskin needs to be performed in a different way to a normal circumcision.  This is because the pee tube can run very close to the skin on the underside of the penis.  This makes it more likely to be injured during the surgery unless steps are taken to protect it.

The operation is also done as a daycare procedure, under a full general anaesthetic.  It takes about 45 minutes to do the surgery.  The risks of this procedure include:

• Bleeding
• Infection
• Injury to the pee tube.  If the pee tube is injured then it will be repaired during the operation.
• Not liking the look of the penis after the surgery.

 

What Happens if I choose for my son to have surgery?

It is important that you discuss what treatment you want for your son with your surgeon.  They will be able to answer any questions that you have to help you make a decision.  If you choose to have surgery then your surgeon will organise for your son to be admitted to Hospital for this.

Once your son is booked for surgery he will have a pre-assessment to ensure that he is fit for surgery and there are no other issues that need to be addressed prior to the operation.

Your son will be admitted, usually on the morning of surgery.  He will need need to fast for before the surgery.  He will be able to eat up to 6 hours before his surgery and drink water until 1-2 hours prior to the operation.  This is to reduce the risks of vomiting when he is having the anaesthetic.

He will be taken to theatre and will go into the Anaesthetic Room.  This is the room where the Anaesthetist will give him a full general anaesthetic and get him off to sleep.  The Anaesthetist will discuss the aesthetic with you on the day of surgery.  Once he is asleep he will be taken into the operating theatre where your surgeon will do the procedure.  Your son will also have a local anaesthetic block (Caudal block or Penile Block)  so that he will not feel any pain when he wakes up.

After the operation is over your son will be woken up from the anaesthetic.  He will be taken to Recovery.  This is a room where people who have just woken up from an anaesthetic are looked after by specially trained staff.  As soon as your son is awake and safe you will be brought to him.

You will then head back to the ward to be observed for a few hours after the surgery.  Normally you will be allowed home once both you and the nursing staff are happy.  You will sent home with pain killers and advice on anything you need to look out for.

After the surgery you will normally be reviewed around 6 months later to ensure that everything has healed normally and that you don’t have any problems.