Postectomy: reasons, surgery and postoperative period

• Postectomy or circumcision is an operation to remove part of the foreskin to expose the glans penis.
• Postectomy can be performed for medical reasons, such as to alleviate phimosis, for religious reasons, such as in Jewish beliefs, or for aesthetic reasons.
• Postectomy surgery is performed on an outpatient basis and has a relatively straightforward post-operative period, although it can be uncomfortable.

This is the main reason why a postectomy is performed and the only one recommended by doctors directly because of the problems caused by this problem. Phimosis is the inability to retract the foreskin that covers the glans both at rest and during erection.

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This can be due to several factors, such as narrowing of the entire foreskin preventing the slightest retraction of the foreskin (complete or filiform phimosis), formation of a fibrous ring preventing complete retraction (annular phimosis) or compression of part of the foreskin allowing only partial retraction (partial annular phimosis).

In these cases, postectomy surgery is performed with the intention of alleviating these problems, thus avoiding possible complications derived from phimosis, such as infections due to the lack of hygiene in the area, discomfort during sexual intercourse and even problems when urinating due to the pressure exerted by the foreskin.

It is common to think of phimosis as a medical problem characteristic of childhood, as most interventions for it occur in early adolescence, but phimosis surgery is also possible in adults.

Postectomy for religious reasons

Circumcision or postectomy is one of the oldest surgeries in history and has been performed for thousands of years, for example, in Jewish culture on all newborns. Similarly, in other cultures, postectomy has also been performed for the medical reasons specified in the previous section.

Postectomy for aesthetic reasons

Nowadays, many men choose to undergo a postectomy operation for aesthetic and hygienic reasons. Due to the decompression of the glans penis when the foreskin and frenulum are removed, as well as the drying of the glans penis, the impression is given that the penis is enlarged. Likewise, after the postectomy, the glans penis loses sensitivity and the duration of sexual intercourse can be increased.

In order to carry out the postectomy surgery, a preoperative examination will be necessary in most cases. Among the tests required for the preoperative examination are an electrocardiogram, a complete blood test and a chest x-ray.

Each of these tests will reveal an important point in order to be able to perform postectomy surgery as safely as possible. For example, the electrocardiogram reveals the state of health of the heart, the blood test reveals whether the patient is in optimal health to undergo the operation, and the chest x-ray reveals whether there are signs of infection.

1. After the pre-surgery, which may be the same day as the surgery or one of the days prior to it, the patient is admitted to hospital. The postectomy is an outpatient procedure, so the patient does not require a room and simply waits in a room until the medical team requests their presence in the operating theatre for the surgery.
2. Once notified, the patient will be taken to a room where he/she will be asked to undress and change into scrubs. After this, the patient will go to the operating theatre and will be placed on a stretcher on his back with his legs apart, similar to the position of pregnant women during childbirth, and a local anaesthetic will be administered to the area. During the postectomy, the patient will feel the penis being manipulated but will not feel any pain or discomfort.
3. When the anaesthesia takes effect, the surgeon will use a scalpel to cut away the excess part of the foreskin and in some cases cut the frenulum freeing the glans, thus avoiding the possibility of it breaking during intercourse.
4. He will then place the stitches and dressings as necessary. These stitches will fall off after a week on their own.
5. The duration of the postectomy is between 20 and 30 minutes. After surgery, the patient will make an appointment for a post-operative check-up and can leave the hospital the same day.

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The postoperative period following a postectomy is relatively simple, although due to the situation of the surgical wound, it can cause some discomfort, especially during the first few days. Below are the different postoperative cares necessary to avoid complications:

• After the postectomy surgery, the urologist will prescribe painkillers to control minor postoperative pain and discomfort.
• Once at home, the patient should take care of the wound by keeping the glans area clean to avoid possible infections in the surgical wound.
• Avoid getting the gauze or bandages that the surgeon has placed on the patient after the postectomy wet for at least the first 24 hours, drying them if they get wet. This does not mean that you should not urinate. On the other hand, once the bandage has been removed, the gauze should be changed daily after washing the wound.
• Due to nocturnal erections, it is recommended to place a basin of cold water at the foot of the bed. This way, if the patient starts to feel tightness in the area due to an erection during the night, just take the feet out of bed and place them in the basin to reduce the problem.
• For the first 10 - 15 days it is very important to carefully wash the wound by drying it in the open air and applying betadine to the area. It is not recommended that soap or dirt gets in, so it is recommended that the penis is washed separately from the full shower.
• In order to protect the glans penis, it is recommended to use gauze, while to reduce possible inflammation, it is recommended to wear tight underwear to avoid rubbing and uncomfortable movements, such as briefs, and to place the penis facing upwards.
• The stitches used in the postectomy will disappear or fall out on their own within 2 weeks of the operation, although this will depend on the particular case.
• If the patient wakes up with a little blood on the gauze there is no need to worry as this is normal due to the aforementioned erections or rubbing during the night.
• The estimated time to return to sexual activity after postectomy surgery is approximately three to four weeks, due to the tightness that can be caused by erections during this period. After that, an active sex life can be resumed without any problems.
• If during the postoperative period at home the surgical wound discharges a yellowish or white fluid, the patient should immediately call his specialist.

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