Circumcision, preputioplasty and dorsal slit
A family hub for definitive or foreskin-preserving treatment of pathological phimosis and for urgent release when circumferential constriction threatens tissue.
Interactive 3D Interactive operative model Open the 3D animation Teaching catalogue only. This coverage record is not a patient pathway or operative instruction.
Typical place in practice
Pathological phimosis, recurrent local disease, selected frenular symptoms, or urgent decompression when conservative reduction is unsuccessful.
Alternatives and neighbouring procedures
Topical and hygiene measures, observation, manual reduction for paraphimosis, or another foreskin-preserving operation when appropriate.
Same procedure family, explicit technique branches
These are variations of this canonical operation. Complication modules below identify whether they apply to all branches or only to named approaches.
Sleeve or dorsal-slit circumcision
Removes the foreskin while protecting glans, urethra and appropriate skin length.
Preputioplasty
Widens a scarred ring while retaining foreskin.
Frenuloplasty
Relieves focal tethering without circumferential foreskin excision.
Emergency dorsal slit
Decompresses a constricting ring when swelling or acute circumstances make definitive excision unsuitable.
High-level sequence
Coverage outline only; not a step-by-step technical guide.
- Confirm indication and exclude concealed glans or urethral pathology
- Control and mark the amount of tissue to release or remove
- Protect the glans and urethra during incision
- Secure haemostasis and reconstruct skin edges
- Check perfusion, urinary passage and wound care plan
Operative notes
Concise operative notes covering the key steps, landmarks and watch points, in the order you encounter them.
Circumcision
What it does: remove the foreskin.
- Foreskin in its natural position. Flaccid penis. No stretch. Mark the outer skin line with a marker pen.
- 2 clips on the distal foreskin, either side of midline. They hold and retract it.
- Cut the outer line. Skin only.
- Dorsal slit in 2 layers. See the meatus before every cut. Never cut blind.
- Outer (superficial) layer first: all the way back to the outer cut.
- Inner (deep) layer next: stop 0.5 cm short of the outer cut.
- Evert the foreskin.
- Mark a 0.5 cm mucosal collar. Cut along it.
- Scissors join the inner and outer cuts. The sleeve comes off. Foreskin to histology.
- Frenulum, ventral at 6 o'clock: bipolar forceps to the frenular artery, then a box stitch at 6 o'clock. The frenular artery is the bleeder.
- Close all the way round: interrupted Vicryl Rapide.
- Dressing: Jelonet (paraffin gauze), then gauze. Crepe bandage optional.
- Watch: Penile block: 9 mL a side. Bupivacaine + lidocaine. Through Buck's fascia, just under the pubis. NEVER adrenaline. It can kill penile skin.
- Watch: Late issues: meatal stenosis, skin bridges.
From the UroRef Operative Quick Guide. Open the note page →
Every failure mode is its own module.
Timing and variation coverage are recorded for each module.
Bleeding or haematoma
Frenular or dorsal-vessel bleeding can collect beneath a tight dressing or skin closure.
Applies to: All variantsGlans or urethral injury
Blind or poorly controlled division can injure the glans, meatus or urethra.
Applies to: All variantsInfection or wound separation
Contamination, haematoma or tissue compromise can disrupt healing.
Applies to: All variantsSkin excess, deficiency or cosmetic asymmetry
Tissue planning affects later contour, tethering and satisfaction.
Applies to: All variantsMeatal stenosis or urinary-stream change
Meatal inflammation or scarring may narrow the outlet, particularly in susceptible children.
Applies to: Sleeve or dorsal-slit circumcisionRecurrent phimosis
A foreskin-preserving or temporising release can re-scar and may later need definitive treatment.
Applies to: Preputioplasty · Emergency dorsal slitSources for this module
Common congenital, acute scrotal and paediatric reconstructive procedures.
Accessed 2026-08-03 · opens source European Association of Urology EAU Guidelines on Sexual and Reproductive HealthPenile prosthesis, Peyronie disease, priapism and reproductive surgery.
Accessed 2026-08-03 · opens source British Association of Urological Surgeons Patient information leaflets by procedureUK patient-facing procedure, alternatives, recovery and complication framing.
Accessed 2026-08-03 · opens source