The prepuce: preservation and reconstruction.

PURPOSE OF REVIEW: To analyze the role of prepuce preservation in various disorders and discuss options available to reconstruct the prepuce.

RECENT FINDINGS: The prepuce can be preserved in selected cases of penile degloving procedures, phimosis or hypospadias repair, and penile cancer resection. There is no clear evidence that debilitating and persistent preputial lymphedema develops after a prepuce-sparing penile degloving procedure. In fact, the prepuce can at times be preserved even if lymphedema develops. The prepuce can potentially be preserved in both phimosis and hypospadias repair. Penile cancer localized to the prepuce can be excised using Mohs' micrographic surgery without compromising survival. Reconstruction of the prepuce still remains a theoretical topic. There has been no study that has systematically evaluated efficacy of any reconstructive procedures.

SUMMARY: The standard practice for preputial disorders remains circumcision. However, prepuce preservation is often technically feasible without compromising treatment. Preservative surgery combined with reconstruction may lead to better patient satisfaction and quality of life.