Circumcision (Phimosis) Surgery in Delhi, India

Phimosis surgery is a medical procedure performed to treat phimosis, a condition where the foreskin of the penis cannot be retracted over the head. The surgery is typically recommended when non-surgical treatments fail, or the condition leads to persistent pain, infections, or difficulty with urination.

The two main types of phimosis surgery are:

• Circumcision: Circumcision surgery involves the complete removal of the foreskin.
  There are many however the important ones are
• Conventional
• ⁠Stapler
• Laser
• ⁠Others

We mostly do stapler circumcision provided no active infection and skin not very thick. This type is the most performed these days.

• Preputioplasty: A less invasive procedure that widens the foreskin opening while preserving it.

The choice of surgery depends on the severity of the condition and the patient’s specific case. Both procedures aim to relieve symptoms, improve hygiene, and prevent complications associated with untreated phimosis.

Phimosis surgery is typically required when the inability to retract the foreskin leads to persistent discomfort, medical complications, or a reduced quality of life. It is considered when non-surgical treatments, such as creams or stretching exercises, fail to improve the condition. Some specific scenarios where phimosis surgery becomes necessary include:

• Frequent Infections: Recurrent episodes of balanitis (inflammation of the foreskin) or urinary tract infections can make surgery essential to reduce the risk of further infections.
• Pain or Discomfort: Severe tightness in the foreskin can cause pain during urination or sexual activity. Surgery is often recommended to relieve this discomfort and restore normal functionality.
• Hygiene Challenges: Difficulty cleaning under the foreskin due to tightness can lead to the buildup of smegma, increasing the risk of infections and odour. Surgery helps eliminate these issues.
• Paraphimosis: In cases where the foreskin becomes trapped behind the head of the penis and cannot return to its original position, surgery is urgently needed to prevent serious complications like restricted blood flow.
• Scarring or Fibrosis: Phimosis caused by scarring from infections or trauma may require surgery if the foreskin loses elasticity and becomes permanently tight.
• Obstructed Urination: In rare cases, phimosis can partially block urine flow, leading to strain during urination or a weak stream. Surgery ensures normal urinary function.

Before undergoing phimosis surgery, there are several steps to prepare for the procedure and ensure a smooth experience. Here's what to expect at Max Hospitals before phimosis surgery:

Initial Consultation

An initial consultation involves an assessment of the severity of phimosis and confirming the need for surgery. Symptoms, medical history, and any previous treatments are discussed. The doctor explains the surgical options, such as circumcision or preputioplasty, along with the benefits, risks, and expected outcomes of the procedure.

Pre-Surgical Examination

A pre-surgical examination is conducted to evaluate the condition and ensure readiness for the procedure. This may include physical checks, blood tests, and other diagnostic evaluations. Any infections or underlying health issues are identified and treated before moving forward with the surgery.

Discussion of Anesthesia

The type of anaesthesia required—local or general—is determined based on the chosen procedure. An anesthetist may provide additional information about the process and check for any allergies or conditions that could affect anesthesia.

Pre-Operative Instructions

Pre-operative guidelines are provided to ensure readiness for the surgery. These may include fasting for a specific period, stopping certain medications temporarily, and maintaining proper hygiene by cleaning the genital area thoroughly. The use of lotions or creams on the day of the surgery is generally avoided.

Phimosis surgery is a straightforward procedure designed to address the inability to retract the foreskin. The process is carefully managed to ensure safety and effectiveness. Here’s what happens during the surgery:

Administration of Anesthesia

The procedure begins with the administration of either local or general anesthesia. Local anesthesia numbs the surgical area while keeping the patient awake, whereas general anesthesia ensures complete unconsciousness during the surgery. The choice depends on the type of procedure and medical recommendations.

Preparation of the Surgical Area

The surgical area is cleaned and sterilised to reduce the risk of infection. The patient is positioned comfortably to allow the surgeon easy access to the site.

Surgical Procedure

• Circumcision: The foreskin is removed entirely, and the edges of the skin are sutured together to create a smooth finish.
• Preputioplasty: A less invasive technique where small incisions are made to widen the foreskin opening, preserving the foreskin while addressing the tightness.

The chosen method depends on the severity of the condition and the surgeon's recommendations.

Closure and Dressing

After completing the procedure, the surgical site is closed with absorbable sutures if necessary. A sterile dressing is applied to protect the area and promote healing.

The recovery period following phimosis surgery is generally smooth with proper care and adherence to medical advice. Here’s what typically occurs after the procedure:

Immediate Recovery

After surgery, the patient is moved to a recovery area where vital signs are monitored. Temporary drowsiness, mild discomfort, or grogginess from anesthesia is common. Most patients who undergo the procedure under local anaesthesia or short general anesthesia may be discharged same day provided they are comfortable enough to leave. Patients undergoing regional/ spinal anesthesia are discharged next day once full effects of anesthesia have waned.

Pain and Swelling

Mild pain, swelling, or tenderness around the surgical site is expected in the first few days. Pain-relief medications and cold compresses can help manage discomfort. Swelling usually subsides within a week.

Wound Care

The surgical site is covered with a sterile dressing that may need to be changed as instructed. Keeping the area clean and dry is essential to prevent infection. Patients are encouraged to take bath after about 5-7 days following surgery.

Activity Restrictions

Rest is advised for the first few days after surgery. Strenuous activities, heavy lifting, and sexual activity should be avoided for a few weeks to allow the wound to heal completely. Walking and light activities can usually be resumed within a day or two.

Follow-Up Appointments

Follow-up visits are scheduled to monitor healing and remove any non-absorbable sutures if needed. These check-ups ensure there are no complications and that recovery is progressing as expected.

Phimosis surgery offers several advantages, addressing both physical discomfort and potential health risks. Here are the key benefits:

Improved Hygiene

One of the primary benefits of phimosis surgery is the ability to maintain better hygiene. After the procedure, the foreskin can be retracted or removed, making it easier to clean the area and prevent the buildup of smegma or bacteria, which can lead to infections.

Reduced Risk of Infections

Chronic infections, such as balanitis (inflammation of the foreskin) or urinary tract infections, can occur due to the inability to properly clean beneath the foreskin. Phimosis surgery significantly reduces the risk of these recurring infections by allowing for better hygiene and reducing the tightness of the foreskin.

Relief from Pain and Discomfort

For individuals with severe phimosis, the tight foreskin can cause pain during urination or sexual activity. Surgery helps alleviate these issues, providing relief from discomfort and improving overall quality of life.

Prevention of Paraphimosis

In cases of phimosis, the foreskin may become stuck behind the glans, causing paraphimosis, a condition where blood flow is restricted. This can be very painful and may require urgent medical attention. Phimosis surgery eliminates the risk of paraphimosis, preventing future complications.

Improved Sexual Function

A tight foreskin can interfere with sexual activity, causing discomfort during intercourse. Phimosis surgery can improve sexual function by allowing the foreskin to be retracted or by removing it, providing greater comfort and enhancing overall sexual health.

Restoration of Normal Urination

In rare cases, phimosis can obstruct the flow of urine, leading to difficulty or pain while urinating. Surgery helps restore normal urinary function by eliminating the blockage caused by the tight foreskin.

Enhanced Psychological Well-Being

For individuals with phimosis, the condition can cause embarrassment or anxiety, especially if it affects sexual performance or causes ongoing discomfort. After surgery, many people experience improved mental health and confidence, knowing that the problem has been resolved.

Long-Term Health Benefits

By addressing the physical limitations caused by phimosis, the surgery offers long-term health benefits, including better hygiene, reduced risk of infections, and improved quality of life. These advantages continue to enhance health well beyond the recovery period.

Although phimosis surgery is generally safe and well-tolerated, like any surgical procedure, it carries certain risks and potential complications. These include:

• Infection: Infection at the surgical site is a common risk. Signs include redness, swelling, increased pain, or discharge, requiring prompt medical attention.
• Bleeding: Excessive bleeding can occur, especially if blood vessels do not clot properly. Additional medical intervention may be necessary to control it.
• Scarring: Minimal scarring is typical, but in rare cases, abnormal scarring (e.g., keloids) may develop, leading to cosmetic concerns or complications.
• Pain or Discomfort: Mild pain is common post-surgery, but persistent or severe pain may indicate an underlying issue and require medical attention.
• Swelling: Swelling around the surgical area is normal but can sometimes become excessive, causing difficulties in urination or blood clot formation.
• Numbness or Sensory Changes: Temporary numbness or altered sensation in the area may occur due to nerve involvement, but it usually resolves over time.
• Recurrent Phimosis: In some cases, the condition may return, particularly after preputioplasty, which may require further treatment or surgery.
• Paraphimosis: If the foreskin becomes trapped behind the glans, it may cause pain and swelling, requiring immediate intervention.
• Urinary Complications: Rarely, difficulty urinating or changes in urinary flow can occur due to swelling or scarring affecting the urethra.
• Psychological Impact: Some individuals may experience emotional effects, such as discomfort with changes in appearance or anxiety about the procedure and recovery.
• Allergic Reactions: Allergic reactions to anesthesia or medications, though rare, may include rash, itching, or difficulty breathing, and should be addressed immediately.

1. How long does it take to recover from phimosis surgery?

Recovery time varies but generally takes about 2 to 4 weeks for most people. Full recovery, including resuming normal activities, can take up to 6 weeks. 

2. Will I need to stay in the hospital after surgery?

Procedure can be performed as day care provided the patient chose local anesthesia or short general anesthesia. If done under Spinal/regional anesthesia then full admission is mandatory. If a patient has an insurance which usually most have, most insurance companies need mandatory 24 hrs admission.

3. Can phimosis come back after surgery?

In some cases, especially after less invasive procedures, phimosis may recur. Follow-up care is important to monitor healing and prevent issues.

4. Is phimosis surgery painful?

Mild pain or discomfort is normal after surgery. Pain is usually well-controlled with medication, and most people experience only mild soreness during recovery.

5. Will I be able to resume sexual activity after surgery?

It’s recommended to avoid sexual activity for at least 4 to 6 weeks post-surgery to allow the area to heal properly.

6. Can phimosis surgery be done on children?

Yes, phimosis surgery can be performed on children if they have persistent phimosis that causes problems, such as pain or difficulty urinating.

7. How do I take care of the surgical site after the procedure?

Keeping the area clean and dry is essential. You’ll be given specific instructions on how to care for the surgical site, including when to change dressings and how to shower.

8. Are there any long-term side effects of phimosis surgery?

Most people do not experience long-term side effects. However, potential issues like scarring, changes in sensation, or urinary problems can occur in rare cases.

9. Can I drive myself home after surgery?

It is advised not to drive yourself home immediately after surgery, as you may still be under the effects of anesthesia. Arrange for someone to take you home.

10. How do I know if something is wrong after the surgery?

If you notice signs of infection (redness, pus, excessive swelling), experience severe pain, or have difficulty urinating, contact your doctor immediately.

Reviewed by Dr. Rohit Kaushal, Senior Consultant - Urology, Kidney Transplant, Robotics and Uro-Oncology on 22 Jan 2025.