Indications of circumcision

Indications of circumcision

Nerve Sparing Esthetic Circumcision

– Phymosis: Phimosis is defined as the inability to retract foreskin covering the head (glans) of the penis. This condition is physiologic in infants and usually resolves around 5-7 years of age.

With false beliefs, parents sometimes try to retract prepucium forcefully that may cause tearing and bleeding and inflammation. It results in a scar tissue at the tip of prepucium called “phymosis ring”. If there is ballooning of the foreskin during urination, difficulty with urination, or infection, then treatment may be warranted.

 – Paraphymosis: In case of retracting forcefully, phymosis ring of prepucium may squeze the glans of penis. Because of circulation of prepucium fails, edema, pain and urine retention occurs. It needs urgent intervention.

 – Balanitis : Balanitis is inflammation of prepucium with yellow discharge caused by infections. After treatment of antibiotic, circumcision may be planned.

 – Trauma: Injuries of prepucium (crushing, abrasion, trapping into a zip, etc…) may necessitate circumcision urgently.

– Recurrent urinary tract infections.

The microbes placed under prepucium may play a role in urinary tract infections. To prevent urinary tract infections, circumcision is advised for patients with congenital urologic anomalies (such as vesicoureteral reflux) and  children who have normal anatomy but suffer frequent urinary tract infections. The percentage of urinary tract infection in circumcised children and uncircumcised ones is 0.1-0.2% and 1.1-4.2% respectively.

References:

  1. Abhinav Agarwal, Anup Mohta, Ritesh K Anand. Preputial retraction in children. Journal of Indian Association of Pediatric Surgeons. 2005 Volume:10 Issue:2 Page: 89-91 http://www.jiaps.com/article.asp?issn=0971-
    9261; year=2005; volume= 10; issue=2; spage=89; epage=91; aulast= Agarwal
  2. Thomas B. McGregor MD, John G. Pike MD FRCSC, Michael P. Leonard, MD FRCSC FAAP. Pathologic and physiologic phimosis: Approach to the phimotic foreskin. Can Fam Physician. 2007 Mar; 53(3): 445–448.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949079/
  3. Koo HP, Duckett JW.:Circumcision-Quo Vadis? Pediatrik Cerrahi Dergisi. 1995; 9,149-154.
    4.Carlos A Angel, MD. Meatal Stenosis. eMedicine June 12, 2006 http://emedicine.medscape.com/article/1016016-overview
  4. J. Shulman, MD; N. ben-hur, MD; Z. Neuman, MD. Surgical Complications of Circumcision. Am J Dis Child. 1964; 107(2): 149-154. http://archpedi.jamanetwork.com/article.aspx?articleid=500844
  5. Teresa To, Mohammad Agha, Paul T Dick, William Feldman. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. The Lancet, vol. 352, number 9143 : pages 1813 – 1816 , December 5 , 1998.
    http://www.thelancet.com/journals/lancet/article/PIIS0140673698023927/abstract
  6. S Mårild, S Hansson, U Jodal, A Odén and K Svedberg. Protective effect of breastfeeding against urinary tract
    infection. Acta Paediatrica Volume 93, Issue 2, pages 164–167, February 2004 http://onlinelibrary.wiley.com/doi/10.1111/j.1651-
    2227.2004.tb00699.x/abstract
  7. Morten Frisch MD PhD, et al. Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision. Pediatrics doi: 10.1542/peds.2012-2896 March 18, 2013
    http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896

Hakan ERDOGAN, M.D
Urologist

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