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Information about your procedure from

The British Association of Urological Surgeons (BAUS)

This leaflet contains evidence-based information

about your proposed urological procedure. We have
consulted specialist surgeons during its preparation,
so that it represents best practice in UK urology. You
should use it in addition to any advice already given
to you.

To view this leaflet online, scan the QR code (right) or

type the short URL below it into your web browser:

KEY POINTS
• This is a short-stay procedure to relieve a tight foreskin
• It is sometimes used in emergency situations when the foreskin is
swollen or stuck in a retracted position (paraphimosis)
• It can be used as an alternative to circumcision in patients who are
unfit or are unwilling to be circumcised
• We make a single incision along the length of your foreskin to
expose the head of your penis without removing any tissue
• The cosmetic appearance after the procedure is not as good as it is
after circumcision
• Circumcision, to remove the foreskin completely, may be needed at
a later stage

What does this procedure involve?

The procedure involves incising the tip of your foreskin to relieve tightness
which is preventing retraction.

It is most often used instead of circumcision in the following situations:

• paraphimosis – an emergency situation where the foreskin is stuck
in a retracted position and has become very swollen;
• patients unfit for circumcision; or
• patients unwilling to be circumcised.

Published: Jun 2024 Leaflet No: A24/078

Review due: Sep 2026 © British Association of Urological Surgeons Limited
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What are the alternatives?

• Observation – with no specific treatment
• Circumcision
• Preputioplasty

What happens on the day of the procedure?

Your urologist (or a member of their team) will briefly review your history
and medications, and will discuss the surgery again with you to confirm
your consent.

You will be seen by an anaesthetist who will discuss the options of a

general, spinal or local anaesthetic. The anaesthetist will also discuss pain
relief after the procedure with you.

You may be given a pair of TED stockings to wear. These help to prevent
blood clots from developing and from passing into your lungs. Your medical
team will decide whether you need to continue these after you go home.

Details of the procedure

• we usually carry out the procedure under a general anaesthetic, but
we sometimes use spinal or local anaesthetic
• we use local anaesthetic nerve blocks, regardless of the type of
anaesthetic, to provide post-operative pain relief
• we may give you an injection of
antibiotics before the procedure,
after you have been checked for
any allergies
• we cut your foreskin along its
length, on the top of the penis, and
stitch the edges of the split
together; this leaves the head of
your penis partially exposed
(pictured right)
• we use dissolvable stitches to
attach the skin of your penis to
your glans

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below.
Some are self-limiting or reversible, but others are not. We have not listed

Published: Jun 2024 Leaflet No: A24/078

Review due: Sep 2026 © British Association of Urological Surgeons Limited
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very rare after-effects (occurring in less than 1 in 250 patients) individually.
The impact of these after-effects can vary a lot from patient to patient; you
should ask your surgeon’s advice about the risks and their impact on you as
an individual:

After-effect Risk

Swelling of the penis which may last for 7- Between 1 in 2 &

14 days 1 in 10 patients

Between 1 in 10 &
Dissatisfaction with the cosmetic result
1 in 50 patients

Between 1 in 50 &
Infection of the incision requiring further
1 in 100 patients
treatment with antibiotics
(1 to 2%)
Between 1 in 50 &
Bleeding from the foreskin incision
1 in 100 patients
requiring a further procedure
(1 to 2%)

Need for removal of excessive skin or Between 1 in 50 &

circumcision at a later date 1 in 250 patients

Anaesthetic or cardiovascular problems Between 1 in 50 &

possibly requiring intensive care (including 1 in 250 patients
chest infection, pulmonary embolus, stroke, (your anaesthetist
deep vein thrombosis, heart attack and can estimate your
death) individual risk)

What is my risk of a hospital-acquired infection?

Your risk of getting an infection in hospital is between 4 & 6%; this includes
getting MRSA or a Clostridium difficile bowel infection. This figure is higher
if you are in a “high-risk” group of patients such as patients who have had:
• long-term drainage tubes (e.g. catheters);
• bladder removal;
• long hospital stays; or
• multiple hospital admissions.

Published: Jun 2024 Leaflet No: A24/078

Review due: Sep 2026 © British Association of Urological Surgeons Limited
 4

What can I expect when I get home?

• you will get some swelling and bruising of the penis which may last
several days
• all your stitches will dissolve, usually within 2-6 weeks
• simple painkillers such as paracetamol are helpful if you have any
discomfort
• any dressing should fall off within 24 hours; if it does not, or if it
becomes soaked with urine, you should remove it
• try to keep the area dry for 24 to 48 hours; avoid soaking in a bath
and you should not swim for one or two weeks
• you will be given advice about your recovery at home
• you will be given a copy of your discharge summary and a copy will
also be sent to your GP
• any antibiotics or other tablets you may need will be arranged &
dispensed from the hospital pharmacy
• a follow-up appointment may be made for you which may involve
admitting you for a scheduled circumcision, if your procedure was
performed as an alternative in an emergency setting
• you will continue to get erections after the procedure but you should
refrain from sexual activity (intercourse and masturbation) for four
weeks, or until the wound is fully healed
• the procedure will not affect your ability to ejaculate and father
children

General information about surgical procedures

Before your procedure
Please tell a member of the medical team if you have:
• an implanted foreign body (stent, joint replacement, pacemaker,
heart valve, blood vessel graft);
• a regular prescription for a blood thinning agent (e.g. warfarin,
aspirin, clopidogrel, rivaroxaban, dabigatran);
• a present or previous MRSA infection; or
• a high risk of variant-CJD (e.g. if you have had a corneal transplant, a
neurosurgical dural transplant or human growth hormone
treatment).

Questions you may wish to ask

If you wish to learn more about what will happen, you can find a list of
suggested questions called "Having An Operation" on the website of the

Published: Jun 2024 Leaflet No: A24/078

Review due: Sep 2026 © British Association of Urological Surgeons Limited
 5
Royal College of Surgeons of England. You may also wish to ask your
surgeon for his/her personal results and experience with this procedure.

Before you go home

We will tell you how the procedure went and you should:

• make sure you understand what has been done;

• ask the surgeon if everything went as planned;
• let the staff know if you have any discomfort;
• ask what you can (and cannot) do at home;
• make sure you know what happens next; and
• ask when you can return to normal activities.

We will give you advice about what to look out for when you get home.
Your surgeon or nurse will also give you details of who to contact, and how
to contact them, in the event of problems.

Smoking and surgery

Ideally, we would prefer you to stop smoking before any procedure.
Smoking can worsen some urological conditions and makes complications
more likely after surgery. For advice on stopping, you can:
• contact your GP;
• access your local NHS Smoking Help Online; or
• ring the Smoke-Free National Helpline on 0300 123 1044.

Driving after surgery

It is your responsibility to make sure you are fit to drive after any surgical
procedure. You only need to contact the DVLA if your ability to drive is
likely to be affected for more than three months. If it is, you should check
with your insurance company before driving again.

What should I do with this information?

Thank you for taking the trouble to read this information. Please let your
urologist (or specialist nurse) know if you would like to have a copy for
your own records. If you wish, the medical or nursing staff can also arrange
to file a copy in your hospital notes.

What sources have we used to prepare this leaflet?

This leaflet uses information from consensus panels and other evidence-
based sources including:
• the Department of Health (England);

Published: Jun 2024 Leaflet No: A24/078

Review due: Sep 2026 © British Association of Urological Surgeons Limited
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• the Cochrane Collaboration; and
• the National Institute for Health and Care Excellence (NICE).

It also follows style guidelines from:

• the Royal National Institute for Blind People (RNIB);
• the Patient Information Forum; and
• the Plain English Campaign.

DISCLAIMER
Whilst we have made every effort to give accurate information, there
may still be errors or omissions in this leaflet. BAUS cannot accept
responsibility for any loss from action taken (or not taken) as a result
of this information.

PLEASE NOTE: the staff at BAUS are not medically trained, and are
unable to answer questions about the information provided in this
leaflet. If you have any questions, you should contact your Urologist,
Specialist Nurse or GP in the first instance.

Published: Jun 2024 Leaflet No: A24/078

Review due: Sep 2026 © British Association of Urological Surgeons Limited