Circumcision requirement in children with phimosis: immediately or elective? (original) (raw)
Related papers
Introduction: Preputioplasty have gained a new interest now days because the retained preputial skin with mucosa after preputioplasty gives good cosmetic appearance and it can be utilized in future for urethral stricture surgery. The aim of this study was to compare the post-operative complications and post-operative hospital stay in patients operated by circumcision and preputioplasty. Methodology: This prospective study included 50 patients (age less than 4 years) having phimosis, treated during July 2010 to July 2012. These patients were treated by two methods viz. circumcision and preputioplasty (25 cases by each method).The patients were assessed post-operatively at day 1, day 15, at 2 months and at 3 months. Results: The study revealed that the immediate post-operative complications like pain, bleeding, oedema, difficulty in micturition and fever were present after both the procedures. But post-operative pain (84%), bleeding (24%) and difficulty in micturition (16%) were higher after circumcision than after preputioplasty (40%, 4% and 4% cases respectively). Post-operative oedema was more prominent in preputioplastyoperated patients (84%). Post-operative hospital stay was longer in cases treated with circumcision. After three months, recurrent adhesions were more common after preputioplasty (32%). Cosmetic appearance was acceptable in patients operated with both the procedures. Conclusion: Preputioplastyis a faster, easier, relatively painless technique with excellent cosmetic results and lesser complications than circumcision, except post-operative edema and adhesions.
Modified partial circumcision for phimosis
Annals of Pediatric Surgery, 2018
Objectives In the last years, many surgical techniques of preputioplasty have aimed to preserve the foreskin in case of phimosis. These techniques are not reliable for patients affected by phimosis linked to balanitis xerotica obliterans (BXO) and scarred foreskin. We tried an original technique of resection of the pathological foreskin, removing the mucosal internal layer followed by reconstruction of the foreskin. The aim was to evaluate the outcome of paediatric patients who underwent modified partial circumcision for pathological phimosis. Patients and methods In all, 360 patients with phimosis underwent modified partial circumcision at our institution. The mean age of the boys was 8.9 years, range 5-15 years. In 145 (40.3%) cases, indication for surgery was clinical suspicion of BXO, in 215 (59.7%) cases it was chronic inflammation of the foreskin. Results In all cases, the postoperative period was uneventful. Cosmesis was considered by parents as excellent in 95.2% of patients. In these patients, the glans was almost completely covered by soft foreskin. Histopathological examination of the removed foreskin documented BXO in 162 (45%). Twelve (3.3%) patients complained of recurrences and five (1.4%) patients of smegmatic cysts. Conclusion The described surgical technique of modified partial circumcision for the correction of pathological phimosis appears cosmetically well accepted, safe, and simple with low rate of late postoperative complications.
Archivio Italiano di Urologia e Andrologia
Background: The literature regarding the quality of the sex life in adult males after circumcision, due to phimosis, is scarce and sometimes contrasting. This could be due to comparisons of a nonhomogeneous distribution of the clinical variables of men who have undergone circumcision. Objective: The objective of this study was to evaluate the distribution of the clinical variables in the adult male population who had circumcision for phimosis, and to propose a clinical classification of the phimosis to characterize it in adult males in more homogeneous sub-groups for the common clinical variables. Materials: A population of 244 adult male patients with phimosis was evaluated retrospectively. The mean age was 50.7 years. Each patient was classified according to the most common clinical variables. The variables that make up this classification of the phimosis were: Position (P1-2) to indicate if phimosis is present when the penis is at rest (P2) or only during an erection (P1); Grade ...
Circumcision for phimosis and other medical indications in Western Australian boys
2003
Spilsbury et al argue that "improved education for physicians, and perhaps parents, with regard to foreskin development and management is required." 1 However, updating of textbooks and medical curricula is required to accomplish this objective. Articles by Caldamone et al 2 and Cendron et al 3 are two examples of incorrect data in text books. Gairdner was the first to provide data on the normal development of the foreskin in young boys. 4 Gairdner incorrectly believed that 92% of boys would have a retractile prepuce by age 5 years. Unfortunately, Gairdner's data was wrong. 5 Gairdner achieved his artificially high rate of retractability by first "running a probe around the preputial space" to break the normal physiological fusion between the foreskin and glans penis, 4 a procedure few would recommend today because of pain, trauma, risk of infection, and iatrogenic creation of adhesions. As stated above, some textbooks continue to uncritically parrot Gairdner's incorrect data. The error has been further compounded by the confusing presentation of data in Øster's otherwise excellent study. 6 Øster presents information about the incidence of "phimosis", "tight foreskin", and "adhesions" in separate tables. To obtain the percentage of boys in each age group with partially or completely non-retractile foreskins, it is necessary to sum the percentage incidence of these conditions. When that is done, Øster's data are very similar to those provided by Kayaba et al 7 on the development of the retractile prepuce. Therefore, according to current research, about 50% of boys will have a retractile prepuce by age 10 years and about 99% will have a retractile prepuce by the
Sexual Medicine
Introduction Male circumcision is recognized as the most effective method of phimosis treatment. Analyzing the literature, the information about the influence of male circumcision due to phimosis for patients' subjective symptoms such as itching, burning, penile pain, pain during intercourse, and quality of sexual life is insufficient. Aim To investigate the effect of male circumcision due to phimosis to patients' subjective symptoms, including erectile function and satisfaction with their genitals. Methods The single-center prospective study began in January 2018 and ended in January 2020. Sixty-nine male, adult patients, who were qualified for circumcision due to phimosis, were included in the study. Main Outcomes Measures The study outcomes were obtained using questionnaires such as visual analog scale 0-10 for itching, burning, penile pain, and penile pain during intercourse; International Index of Erectile Function (IIEF-5) and Male Genital Self Image Scale 7 (MGSIS-7) ...
Archives of urology, 2018
Background: Phimosis is a common indication for circumcision. The finding of a trapped penis with significant penile abscess collection and urinary retention in a male infant following circumcision at home is indeed a rare occurrence. Case History: A 18 months old male child was rushed to the Children's emergency unit with acute urinary retention, grossly swollen and trapped penis. There was a preceeding history of poor urinary stream five weeks following circumcision at home. Examination revealed a child in acute urinary retention with a grossly swollen, soft, fluctuant and tender mass concealing his penis. Abdomino pelvic Ultrasound scan revealed a distended urinary bladder with evidence of back pressure effects on both kidneys. He had immediate urinary diversion via a suprapubic puncture and subsequently in a few hours, had a redo circumcision. Conclusion: Male circumcision remains the surgical procedure which must be performed by practionner with expertise at hospital, in order to minimise the tragic complications.
A Holistic Approach to Phimosis in Children
Journal of Ayurveda and Integrated Medical Sciences (JAIMS), 2018
Phimosis is described as condition in which prepuce or foreskin of glans penis is not retracted backwards resulting in poor narrowed stream of urine during micturition causing ballooning of prepuce along with recurrent attacks of balanoposthitis and Urinary Tract Infections (UTIs). Majority of new born boys do have non-retractile foreskin called as Physiological Phimosis. In Ayurveda phimosis is described as Nirudhaprakasha. Physiological phimosis usually does not require any kind of treatment as it resolve spontaneously within first couple of years mostly taking 3 to 6 years after which measures are considered to correct it surgically. Pathological phimosis is condition in which prepuce get adhered to glans secondary to adhesions or scarring made because of infection, inflammation or trauma. Pathological phimosis and physiological phimosis with recurrent attack of balanoposthitis and UTIs do require treatment. There are several treatment modalities are available according to severi...
Inappropriate Circumcision: Referrals by General Practitioners
Journal of Paediatric Surgeons of Bangladesh, 2015
A large proportion of general practitioners have difficulty in discriminating between a true phimosis and a developmentally non-retractile foreskin. This diagnostic inaccuracy was greatest when the referring doctor did not examine the patient and inappropriately refer the patient to a pediatric surgeon for circumcision due to fear of obstructed voiding. From July 2005 to April 2007 total 33 boys with physiological phimosis were assessed in BSMMU. Among them 20 cases were without ballooning and 13 cases with ballooning. All the boys had upper tract and bladder USG followed by uroflowmetry and USG to determine post-void residual urine volume. Data were compared between boys with and without ballooning of foreskin. In all 33 boys with physiological phimosis completed uroflowmetry and USG. Ballooning of the foreskin was present in 13 boys (mean age-22.08 months range from 18 to 25 months) and non ballooning were 20 (mean age-22.7 months range from 18 to 28 months). Upper tract USG and bladder wall thickness were normal in all boys. The mean Maximum flow rate (Q max) was not significantly different in boys with ballooning and those with non ballooning (mean 8.4ml/s maxi-10.3 mini-6.7-) vs (8.5 ml/ s, maxi-10.7,mini-6.7). In addition all Qmax values were within normal range. The two groups had comparable mean PVR (0 .92 ml SD-0.9, range-0 to7) vs (.85 ml SD-0.8 range 0 to 8). The non-invasive assessment of voiding efficiency in boys with physiological phimosis with or without ballooning of foreskin showed no evidence of
Phimosis and Circumcision: Concepts, History, and Evolution
International Journal of Medical Reviews
Phimosis is classically characterized by the impossibility of completely withdrawing the foreskin and exposing the glans. A distal preputial narrowing occurs, which may be congenital or acquired. Excess foreskin and the presence of balanopreputial adhesions may be components of this spectrum. Circumcision corresponds to foreskin excision, one of the most commonly performed surgeries in boys, whether for medical or religious reasons. Such a procedure is considered sacred by many peoples around the world as a symbol of faith or even as a ritual of tribal emancipation. The appearance of the procedure in several places and times allowed the development of the surgical technique, today adapted to minimize complications and provide evident medical benefits. We present fundamental physiological and histological concepts, classically described, knowing the natural history of a potential disease. We discuss the emergence and development of surgical techniques still used today and identify factors that interfere with the disease and influence the treatment.
Concealed Penis and Urinary Retention in a Child with Severe Phimosis : A Case Report
2016
Background : Phimosis is a common indication for circumcision. The finding of a concealed penis with significant penile abscess collection and urinary retention in a male infant following circumcision at a peripheral center is indeed a rare occurrence. Presentation : A 1 year old male child was rushed to the Children emergency unit with acute urinary retention, grossly swollen and concealed penis. There was a preceeding history of poor urinary stream four weeks following circumcision at a peripheral center. Examination revealed a child in acute urinary retention with a grossly swollen, soft, fluctuant and tender mass concealing his penis. Abdomino pelvic Ultrasound scan revealed a distended urinary bladder with evidence of back pressure effects on both kidneys. He had immediate urinary diversion via a suprapubic cystostomy and subsequently had a re-do circumcision. Conclusion : Poor circumcision techniques can lead to a wide array of complications. Circumcision is better carried out...