Plastibell Circumcision of Babies with Hooded Prepuce: New Technique (Traction and Closure) and Case Series

Background: Circumcision is the most common procedure in the neonatal period. PD was adopted for circumcision for a long time, and it underwent many modifications during the last decades. In this paper, we review retrospectively our practice in babies with isolated hooded prepuce that been circumcised with PD by using a new technique called (Traction and closure). Materials and methods: Between April 2019 and April 2021, 676 cases of circumcision were performed in the pediatric surgery clinic, 398 cases by Winkelmann clamp, and 289 done with Plastibell device. Five cases of hooded prepuce were detected on routine physical examination without hypospadias or meatal anomaly. These cases are characterized by deficient ventral preputial skin comparing to the dorsal pre-putial skin. All babies were in the neonatal period (less than one month of age) except for one who was 32 days old. The mean age of babies was 15.4 days. Circumcision was accomplished with PD by a new technique (Traction and closure). Results: Postoperatively no bleeding or urinary retention was noticed in all babies. Upon follow-up, all patients did not have slippage or retention of the ring where the ring fell smoothly over an expected time duration (7-11 days, mean: 9.25 days). Also, good favorable outcomes and parental satisfaction were both obtained in all cases. Conclusion: PD with technique (traction and closure) is a safe and suitable method for circumcision in babies diagnosed with an isolated hooded prepuce. Key Words: Plastibell, hooded prepuce, circumcision, new technique