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A review on the history of and treatment options for foreskin reconstruction after circumcision

Abstract

Circumcision is arguably one of the most performed procedures in the world and transcends cultures, nationalities, and religions. New insights into the motivations of men seeking circumcision reversal was the incentive to further investigate known reconstructive therapies. Therefore, the purpose of this study is to present an overview of the historical context and treatment options known for foreskin reconstruction. This review was written after a comprehensive literature search on PubMed, EMBASE, Web of Science, MEDLINE, SCHOLAR databases, and additional Google searches. The practice of foreskin manipulation and the undoing of penile circumcision has a long and turbulent history going back to antiquity. Nowadays, the available data on treatment options remains sparse, focusing primarily on surgical techniques and is generally poorly documented. Nonsurgical methods of reconstruction are rarely mentioned in literature. Nonetheless, nonsurgical methods, such as manual stretching and device-assisted tissue expansion, are commonplace among those who pursue foreskin reconstruction. Although the nonsurgical methods have yielded good results with minimal adverse effects, no proper medical research has been performed to quantify these outcomes. Future studies should also be performed to assess the impact that foreskin reconstruction has on quality of life in this population.

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Fig. 1: A PRISMA flow chart on the literature search.
Fig. 2: A presentation of the two historical approaches to cover the glans.
Fig. 3: Second procedure proposed by Celsus.
Fig. 4: Procedure by Goodwin, a modification of a method previously described by Feniz.
Fig. 5
Fig. 6

Data availability

Pubmed Search: ((“Foreskin”[Mesh] OR foreskin*[tiab] OR prepuce*[tiab] OR praeputium[tiab] OR preputium[tiab] OR praeputial[tiab] OR preputial[tiab]) AND (“Reconstructive Surgical Procedures”[Mesh] OR reconstruct*[tiab] OR restor*[tiab] OR rehab*[tiab] OR repair*[tiab])) AND (“Circumcision, Male”[Mesh] OR circumcis*[tiab] OR uncircumcis*[tiab] OR post-circumcision[tiab]OR decircumcision[tiab] OR uncircumcision[tiab]). Embase/Medline Search: Circumcision AND Decircumcision OR Foreskin OR Foreskin Restoration OR Reconstruction OR Restoration AND Uncircumcision.

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Contributions

FWT: methodology, investigation, writing—original draft; SEM: writing—review and editing, visualization; SCZPT: writing—review and editing, visualization; M-BB: writing—review and editing; MÖ: conceptualization, investigation, supervision, and project administration.

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Correspondence to Müjde Özer.

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Timmermans, F.W., Mokken, S.E., Poor Toulabi, S.C.Z. et al. A review on the history of and treatment options for foreskin reconstruction after circumcision. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00438-3

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