Prepuce

Key points

Dorsal penile nerve blocks

incomplete block at the level of the frenulum due to additional innervation from the perineal nerve - needs ring block

Glans ischaemia

Can happen due to penile block

Resolves with sildenafil, enoxaparin, levobupivicaine caudal for vasodilatory effect

Glans injury

Primary repair - replantation of glans

Can do urethrostomy if severe injury

Zipper injuries

Compression for 20 mins, use oil to release or cut zipper with bone cutter

Minor lacerations - chloramphenicol

Megaprepuce

Large redundant inner prepuce causing appearance of ballooning at base as it fills with urine

Can look like buried penis

Can present with UTIs

Needs modified circumcision - may need to be staged repair

References

Werner Z, Hajiran A, Al-Omar O. Congenital Megaprepuce: Literature Review and Surgical Correction. Case Rep Urol. 2019 May 14;2019:4584609. doi: 10.1155/2019/4584609. PMID: 31218089; PMCID: PMC6536951.