V08_No_1_Print_3.pdf


Pictorial Urology

13Urology Journal   Vol 8   No 1   Winter 2011

Post Circumcision “Tri-Balanic” Penis
Urol J. 2011;8:13.

www.uj.unrc.ir

A 32-year old man presented to the outpatient clinic of our department complaining of intractable pain, 
considerable congestion, and edema of the glans of the penis. The patient was afebrile, complaining of 
dribbling and inability to urinate properly.

The patient’s history included a recent (less than one month) operation for the penis circumcision in 
another institute, while the physical examination revealed glans lobulated and struggled.

Under general anesthesia, the stitches were released and the redundant part of the prepuce was excised 
as to release the compression of the glans, leaving the glans free and totally uncovered. Following this 
procedure, the edema and congestion improved.

This case represents a rare case of circumcision repair-induced paraphimosis. Rules to be followed in 
order to avoid this complication are removal of adequate part of the prepuce, careful detachment of 
adhesions between the inner surface of the prepuce and superficial surface of the glans,(1) gentle removal 
of the smegma, extreme pull back of the prepuce behind the corona of the glans,(2) and careful ligation of 
the artery and veins.(3)

Konstantinos Michalakis, Ioannis Ilias, Charalambos Asvestis
Elena Venizelou General Hospital, Athens, Greece

E-mail: kostismichalakis@hotmail.com

REFERENCES
1. Elder JS. Circumcision. BJU Int. 2007;99:1553-64.

2. Muula A, Prozesky H, Mataya R, Ikechebelu J. Prevalence of complications of male circumcision in Anglophone Africa: a 
systematic review. BMC Urol. 2007;7:4.

3. Holman J, Stuessi K. Adult circumcision. Am Fam Physician. 1999;59:1514-8.