Surgical lysis of preputial adhesions is indicated when natural processes – smegma accumulation and suppuration, spontaneous erections – fail and the boy is in just prepubertal age. Leving an adolescent alone with this “problem” can lead to psychological discomfort and sexual malfunction.
Separating the adhesions in earlier age usually is unsuccessful. The moment of the procedure is painful, the child feels fear and it is almost an act of violence. The surface of the glans and the prepuce heal for a couple of days, and if not retracted regulary the skin with glue to the glans. Usually the child does not accept this and the parents give up. Many of this foreskins show typical for the first years of life “narrowness” and fragility, what makes things even more difficult.
Unfortunately, there are surgeons who offer the procedure in general anesthesia. This carries the risk of general anesthesia and rarely leads to resolution of “preputial problem”. In this case the family is left alone with care of swollen and painful glans.
Till pubertal age most foreskins spontaneously gain elasticity, become retractable and separete from the glans. If adhesions are still present, it is usually much smaller area. The young man will soon stay alone with his “problem”. So in this age there is a reason to treat preputial adhesions.
The whole procedure takes a few minutes, and the painful part just 20 seconds. The key to success is motivation and reward for the patient. He is expected to stay still for a moment and then take proper care of the glans for a few days. I belive that EMLA applied topically for an hour in occlusive dressing relives the pain effectively during the procedure.