- Stretched Penile Length (SPL) cm
- The length of the penis measured from the pubic bone to the tip of the glans while the penis is gently stretched to its full extent. Used to assess tissue availability for excision planning. Population mean is 13.0 cm (SD 1.8 cm) per Veale et al. 2015.
- Foreskin Overhang cm
- The length of prepuce that extends beyond the tip of the glans when the penis is in a relaxed state. Values above 2.0 cm are associated with hygiene complications and increased phimosis symptoms.
- Glans Coverage Ratio
- The proportion of the glans penis covered by the prepuce at rest. Ranges from 0.0 (glans fully exposed) to 1.0 (glans completely covered). A ratio above 0.9 typically indicates significant phimosis or redundant prepuce.
- Inner/Outer Prepuce Ratio
- The proportion of the total prepuce length that is composed of inner mucosal (epithelial) tissue versus outer skin. A typical ratio is 0.3–0.6. Values outside this range may influence technique selection and wound closure planning.
- Kikiros Phimosis Grade scale 0–5
- A validated 6-point scale for grading the severity of phimosis based on the degree of foreskin retractability. Grade 0 = full retraction with no tightness. Grade 5 = absolutely no retraction possible. Grades 3 and above are considered clinically significant and increase surgical complexity.
- Frenulum Tension Grade scale 0–3
- A 4-point scale assessing tightness of the frenulum (the band of tissue on the underside of the glans). Grade 0 = no tension. Grade 3 = frenulum breve, causing pain or ventral curvature on retraction. Grades 2 and above may warrant concurrent frenuloplasty.
- Frenulum Breve
- An abnormally short or tight frenulum that restricts retraction, causes pain during erection, or produces ventral curvature of the glans. Clinically significant at Frenulum Tension Grade 2 or above. May require frenuloplasty as an adjunct to circumcision.
- Micropenis
- Defined as a stretched penile length more than 2.5 standard deviations below the population mean (approximately 8.5 cm in adults per Wessells et al. 1996). In circumcision planning, this flag indicates reduced tissue availability and warrants conservative excision margins.
- Sleeve Resection
- The most common adult circumcision technique. The outer and inner preputial layers are excised circumferentially as a single sleeve of tissue. Provides precise control over the amount of tissue removed and is the reference standard in this model.
- Dorsal Slit with Excision
- A technique in which a longitudinal incision is made along the dorsal surface of the prepuce before excision. Associated with higher wound edge tension and increased risk of dehiscence compared to sleeve resection.
- Complexity Score
- A count of active clinical risk flags (0–6) derived from the patient's measurements and grading scores. Higher scores indicate greater surgical complexity and are used alongside the weighted risk score to guide pre-operative planning.
