Day +1, Dressing Removal

Twenty four hours passed since the procedure. The last night did not cause any major problems. On the zero-to-ten scale, my pain level went up to around three in the evening, so I decided to take my first pill of pain killers. I am not sure if that was the actual pain or discomfort caused by the fact that I had to put ice on my penis for the night. Anyway, I was asleep twenty minutes later and woke up today pain-free. I did not need any pain killers throughout the day.

Today I got to remove the dressing from the penis. It was a bit scary to do it by myself, but I was eager to see the result. I found that Dr. Baum made one dorsal incision (as planned) and cut my frenulum. Due to the single cut, I see a slight cleft at the top. At the same time, I realize that this is too early to judge the final result. The frenulum area is still bleeding somewhat but this is no more than a couple of drops an hour. Again, no pain. I urinate with no problems as well, with no change in the feeling. Here are the pictures of day 1:

Day 0, The Day of Procedure

Today was the big day — I had preputioplasty and frenulotomy done. From the time I arrived to the Center to the time I was dispatched, less than two and a half hours passed. I went through a standard routine of paperwork and pre-op procedures such as changing clothes, emptying my bladder, and IV. The procedure was done under a general anesthesia and took less than one hour. So, when I woke up everything already had happened. My penis is still covered in dressing, so there isn’t much to see. There is a hole at the top of the bandage so that I can pee. Surprisingly, peeing is not painful. I get to wear the dressing for 24 hours.

On the zero-to-ten scale for pain, I am between zero and one. I don’t even take my pain medicine. So far, there has been no need for that. Doctors instructed me to put ice on my penis every hour for 20 minutes, and then for the whole night tonight to reduce possible swelling.

…Curious to see what’s inside.

Day -2

Today Dr. Baum called me with answers to my questions. He only performs preputioplasty with one dorsal incision. I guess this is my second best option because studies show that two incisions leave a slightly better cosmetic result and avoid a cleft in the foreskin on the top of the penis. I also wonder if two incisions make the foreskin wider than one incision. He gave me no reply to my question about BXO. I am still going to stick with the plan.

At the same time, I find more sources that say preputioplasty is not an option if BXO is present because the continuing inflammatory process results in recurrent stenosis of the preputial orifice. I am still going to try preputioplasty for two reasons. If I do have BXO indeed, it is of the slightest form (my penis is not nearly as scary as some penises on pictures of BXO). Also, I can always undergo circumcision if preputioplasty does not help, but not vice versa.

More information: http://www.ispub.com/journal/the-internet-journal-of-surgery/volume-18-number-1/bilateral-lateral-slit-preputial-plasty-a-technique-preferred-over-circumcision-in-primary-phimosis.html

http://urologycentre.com.sg/bxo_treatment.html

http://www.google.com/url?sa=t&rct=j&q=prepuce%3A%20phimosis%2C%20paraphimosis%2C%20and%20circumcision&source=web&cd=4&ved=0CDkQFjAD&url=http%3A%2F%2Fdownloads.tswj.com%2F2011%2F405910.pdf&ei=in1yT7fLEcPi2gWU-OGCDw&usg=AFQjCNE0otITK0wYPDmAFxqaInJrj714Ug

Day -4, BXO

Today I think I found the answer to my question about the link between white patches and tight foreskin (see the very first post of this blog here). Lichen sclerosus. Thought to be the most common cause of phimosis, lichen sclerosus is a dermatological condition manifesting as white patches on the foreskin and glans; often a hard, white ring of tissue develops, which may prevent retraction. What causes lichen sclerosus is not certain, although theories range from bacterial or viral infection (especially with HPV – human papilloma virus) to autoimmune diseases. Lichen sclerosus is also called balanitis xerotica obliterans (BXO).

Here are more links to information about BXO:

http://www.dermaamin.com/site/atlas-of-dermatology/2-b/147-balanitis-xerotica-obliterans-.html

http://en.wikipedia.org/wiki/Balanitis_xerotica_obliterans

http://www.centerforreconstructiveurology.org/urethral-stricture/lichen-sclerosis-bxo.htm

I guess it is good that I found some explanation to my problem. Also, it seems like this finding does not change my treatment as most studies recommend circumcision/preputioplasty for BXO. Except for this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539601/

I also see different techniques describing preputioplasty in different sources. Some recommend one incision, others recommend two or more.

Definitely now I have more questions to ask Dr. Baum.

I am still puzzled why it is I who searches for answers and then presents them to doctors, and not vice versa.

Day -7, Pre-Op

Today I had two pre-op visits. One with the nurse of Dr. Baum, and another one with the Surgery Center personnel. The procedure will be performed at the Ambulatory Surgery Center of Touro. Preputioplasty and frenulotomy are considered outpatient surgeries. Both nurses said that the whole time I will spend at the Center on the day of the surgery should be between four and five hours. I got two prescriptions, one for pain medication after the surgery, and one for antibiotics to start one day before the procedure. The rest was basically signing papers and consents.

I know that a lot of people wonder how expensive this procedure is. The total price that Dr. Baum’s office charges is around $1500. The official diagnosis is phimosis, and my insurance covers it. So, in total, I paid out-of-pocket around $200 to Dr. Baum. I will post how much the bill from the Ambulatory Surgery Center of Touro is.

First Visit to Dr. Baum

Today was my first visit to Dr. Neil Baum. First of all, it was at least a thirty minute conversation. He carefully looked at my penis and realized what the problem was. Also, he wanted to see the condition when the penis is erect, so he asked me to take pictures of my penis while erected and send them over to him. Here is an example of what I sent:

Dr. Baum presented me with my options: do nothing (since I still can open the head), full circumcision, and preputioplasty. Frenulotomy will still help, he said. When I told him that I like my foreskin, he replied that then there is no reason to part with it. I showed him the same articles I showed Dr. Prats, and he replied that he is aware of them. He also briefly explained how preputioplasty is done.

Overall, I am satisfied with the visit and am eager to hear from him once he receives my pictures.