Y-V preputioplasty for adult phimosis: a review of 89 cases.

OBJECTIVES: Numerous surgical techniques have been proposed for preputial relief to avoid circumcision. We aimed to review the indications, techniques, and outcomes of Y-V preputioplasty for men with phimosis treated at our institution between 1995 and the present. METHODS: We retrospectively examined the case notes of 89 patients who underwent Y-V preputioplasty since 1995. Indication, technique, and immediate outcomes were recorded. We have subsequently attempted to contact these patients for the completion of a satisfaction questionnaire. RESULTS: All case notes were retrieved; 87 of 89 procedures were undertaken by a single surgeon (I.A.). The median age at operation was 29 years (range, 18-84 years) and median follow-up was 4 years. Seven patients required revision surgery (3: Y-V preputioplasties; 2: circumcisions; 1: adhesion division; and 1: frenuloplasty), whereas 2 patients reported unresolved symptoms but have not undergone additional procedures. Currently, we have successfully contacted 31 of 89 (35%) patients by telephone. These cases appear to have similar demographic features to the whole group. All agreed to complete a satisfaction questionnaire, and 30 replies were received. Overall, 12 patients (40%) were very satisfied and 10 (33%) were satisfied, whereas 4 (13%) were indifferent and 4 (13%) were dissatisfied. Two patients have subsequently undergone circumcision. Twenty-one (70%) patients described their cosmetic result as very good or good, and 22 (73%) patients would recommend the operation to a friend. Dissatisfaction with the procedure seemed to be associated with pre-existing erectile dysfunction, and not retracting the foreskin postoperatively. CONCLUSIONS: Y-V preputioplasty would seem a good alternative to circumcision for men with phimosis who wish to preserve their foreskin.

Urothelial adenocarcinoma in a non-functioning bladder.

Urinary diversion is a common final outcome in patients with refractory long-term incontinence. It is even more common in young patients with neurogenic bladders and in such cases the bladder is disconnected and left in situ. We present a unique case of adenocarcinoma of the bladder which occurred 31 years following such a diversion procedure. We ask whether, despite the comorbidity associated with cystectomy, the patient is in danger of developing effectively silent tumours within these non-functioning bladders.