Background: Phimosis is a common pediatric condition, yet the default treatment remains circumcision, which results in the irreversible loss of specialized tissue. This study evaluates the outcomes of a modified tri-incision preputioplasty as a foreskin-preserving alternative.

Methods: Fifty consecutive boys (<12 years) with pathological phimosis underwent a modified tri-incision preputioplasty between January 2018 and August 2019. Under caudal block and short general anesthesia, a transverse dorsal incision was made with bilateral lateral longitudinal incisions. Outcomes included prepuce retractability, complications, cosmetic grading, and parental satisfaction assessed up to three months post-operatively.

Results: The median age was 4 years. Complete prepuce retractability was achieved in 100% (n=50) of patients at three months. Pre-operative symptoms, including ballooning (54%) and UTI (12%), resolved completely. No major complications like meatal stenosis or wound infection occurred. Cosmetic outcomes were rated as “Excellent” in 70% and “Good” in 24%. Parental satisfaction (Likert ≥ 4) was recorded in 94% of cases.