Simplificación del tratamiento quirúrgico del pene oculto / Simplification of the surgical treatment of a hidden penis

Introducción: El tratamiento del pene oculto consiste en llevar a cabo una exteriorización completa del cuerpo del pene, que resulte efectiva desde el punto de vista funcional y estético. Pacientes y métodos: A lo largo de 15 meses (febrero de 2008 a mayo de 2009) hemos tratado 7 niños (edad media: 4,6 años) con pene oculto (5 con pene enterrado, uno palmeado y otro atrapado) con la reconstrucción de Borsellino modificada mediante incisión en «S» en la parte dorsal. En un paciente se realizó lipectomía púbica a través de la misma incisión. La indicación quirúrgica fue por motivos estéticos en todos los casos, fimosis secundaria en 4, balanitis de repetición en uno y dolor en otro. Resultados: La estancia hospitalaria fue de 24 horas. Con un seguimiento a corto plazo (1-12 meses) las complicaciones detectadas fueron: recidiva parcial, linfedema posquirúrgico y cicatriz hipertrófica, cada una de ellas en un caso. Pacientes y padres se encuentran satisfechos con el resultado. Conclusiones: La técnica que presentamos consigue un buen resultado cosmético y presenta pocas complicaciones inmediatas. La sustitución de las dos incisiones dorsales por una sola en «S» permite lipectomía simultánea sin nueva incisión (AU)

Introduction: The treatment of a hidden penis consists of completely and effectively exteriorizing the penile shaft from a functional and aesthetic point of view. Patients and methods: Over a period of 15 months (02/2008-05/2009), we treated 7 children (mean age 4.6 years) with hidden penis (five had a buried penis, one had a webbed penis and another a trapped penis) using the Borsellino reconstruction technique modified with an ‘‘S’’ dorsal incision. We performed a pubic lipectomy in one patient through the same incision. Surgical indication was for aesthetic reasons in all the cases, secondary phimosis in four, repeated balanitis in one and pain in another. Results: Hospital stay was 24 hours. With a short-term follow-up (1-12 months), we detected the following complications: partial recurrence, post-surgical lymphedema and hypertrophic scarring, each of them in one case. Patients and parents were satisfied with the result. Conclusions: The technique that we present achieves good cosmetic results and has few immediate complications. The substitution of the two dorsal incisions with one ‘‘S’’ incision allows simultaneous lipectomy without the need for another incision (AU)

Necesidad de circuncisión o dilatación del prepucio. Estudio de 1.200 casos / The need of circumcision or prepuce dilation. A study with 1200 boys

Objetivos: Demostrar el incremento de la retractilidad del prepucio con la edad. Señalar la poca utilidad de la circuncisión y la dilatación forzada del prepucio en la infancia. Métodos: El desarrollo del prepucio y su retractilidad, a medida que avanza la edad, fueron evaluados en 1200 niños de 0 a 16 años. El prepucio fue catalogado en tipos I a V según fue de menor a mayor su retractilidad en todos los casos que habían sido o no dilatados previamente. Resultados: La retractilidad del prepucio en los niños menores de un año en el tipo I (no retráctil) fue 63,4 %, mientras en el tipo V (completamente retráctil) fue tan solo 3,7 %. Lo contrario se observó en los adolescentes (11 a 16 años) en los que el tipo I fue 0,9 %, mientras el tipo V se observó en 80,9 %. También se encontró que 309 niños (43,1%) de los 717 niños que habían sido dilatados forzadamente su prepucio, cuando eran mas pequeños, tenían prepucios tipos I al IV, es decir, habían adquirido nuevamente adherencias balano-prepuciales en el momento del examen para nuestra investigación. Se observó que 17 niños de los examinados (0,4%) estaban necesitados de que se les realizara circuncisión. Ningún niño sufrió infección del tractus urinario superior. Conclusiones: Todos los niños nacen con el prepucio cubriéndole el glande, si no tienen una anomalía congénita del pene, manteniendo unas adherencias entre ambas estructuras, las que van desapareciendo con la edad, siendo total la separación en la pubertad, en la mayoría de los niños. Por ello consideramos la circuncisión o la dilatación forzada del prepucio innecesaria en la mayoría de los niños (AU)

Objectives: To demonstrate the increase of preputial retractability with age. To point out the small usefulness of circumcision and preputial forced dilation during childhood. Methods: The development of the prepuce and its retractability were evaluated in 1200 boys between 0 and 16 years. The prepuce was classified as type I to V depending on its lower or higher retractability in all cases having been dilated previously or not. Results: Prepuce retractability in boys under one year was type I (not retractile} in 63.4%, whereas it was type V (completely retractile) in only 3.7%. The contrary was observed in adolescents (11 to 16 years), in which type I was 0.9% and type V was observed in 80.9%. It was also observed that 309 boys (43.1%) among the 717 with previous prepuce forced dilation, had types I to IV prepuces, so, they had acquired new balanopreputial adherences by the time of examination for our study. Seventeen boys (0.4%) required circumcision. No children suffered upper urinary tract infections. Conclusions: All boys are born with the prepuce covering the glans penis, keeping adherences between both structures, which disappear with age, being the detachment complete at the time of puberty in most boys. So, we consider circumcision or forced dilation of the prepuce unnecessary in most boys (AU)

[Early effect of non-surgical treatment using betamethasone valerate ointment for phimosis in childhood].

We evaluated the early efficacy of non-surgical treatment using 0.07% betamethasone valerate ointment on, 34 boys with phimosis between January 2001 and June 2005. Patients were treated with 0.07% betamethasone valerate ointment applied to the distal aspect of the prepuce every other day for 2-6 weeks. During the treatment period, patients were instructed to retract the foreskin to penis root without overstraining. The overall success rate was 94.1% and therapeutic effects were observed in 58.8% of the patients in two weeks. There were no medical side effects. Treatment using betamethasone valerate ointment is very effective, easy and safe. We recommend this treatment for patients with phimosis and/or those with recurring balanoposthitis.

High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study.

This prospective study was designed to address the incidence and clinical and histologic characteristics of balanitis xerotica obliterans in a large random pediatric population with phimosis. We investigated 1178 boys who presented consecutively with phimosis between 1991 and 2001. All patients who underwent complete circumcision and surgical specimens were typed histologically as early, intermediate, or late forms of this disorder or as nonspecific chronic inflammation. Patients with balanitis xerotica obliterans were controlled at 1, 6, and 12 months postoperatively, then yearly. Balanitis xerotica obliterans was found in 471 of the 1178 patients (40%), with the highest incidence in boys aged 9 to 11 years (76%). Secondary phimosis occurred in 93% of boys with balanitis xerotica obliterans and in 32% of those without the disorder. In six instances of balanitis xerotica obliterans, meatotomy and in one meatoplasty was performed, as well as circumcision. On histologic evaluation, we found 19% had early, 60% intermediate, and 21% late form of balanitis xerotica obliterans. Glanular lesions disappeared completely within 6 months in 229 out of 231 patients. Our data strongly suggest that the true incidence of childhood balanitis xerotica obliterans is higher than previously assumed. Its incidence peaks in the 9 to 11 years age group, in whom secondary phimosis was almost exclusively caused by balanitis xerotica obliterans.

[Preputial development in Japanese boys].

The natural course of preputial development is still not clearly understood. The preputial retractability was evaluated in 242 Japanese boys. The incidence of having a retractable prepuce gradually increased with age from 0% at age 1 year to 77% by the age of 11 to 15 years. In 48 boys, preputial development was followed up for 2 to 10 years with the self-retract maneuver. Non-retractable prepuce was found in 9 boys, which then became retractable within 2-7 years. The prepuce became retractable in most of the boys with balanoposthitis. In conclusion, forced retraction or circumcision is unnecessary for phimosis in boys with or without balanoposthitis.

Fimose e circuncisão: uma eterna polêmica com relação às condutas / Phimosis and circumcisions: a controversy in relation to procedures

A fimose se caracteriza pela presença de uma constriçäo no extremo distal do prepúcio, que impede a retraçäo do prepúcio sobre a glande. Circuncisäo é o tratamento indicado em qualquer situaçäo; todavia, um importante indicador para a postectomia é quando o estreitamento do prepúcio causa obstruçäo urinária. Nos últimos 27 anos, tenho usado a técnica com plastibell, com resultados bastante satisfatórios. No entanto, ela näo está indicada naqueles pacientes em vigência de balanite ou com cicatriz disforme de prepúcio. Essa técnica é simples de executar e exige menos tempo do que a postectomia clássica. Com relaçäo aos aspectos funcional e estético do prepúcio, os resultados säo superiores. Concluo que me pareceu infinitas as discussöes sobre a indicaçäo da circuncisäo e também tenho a impressäo de que a mesma faz parte de nossa cultura e tradiçäo. Entretanto, sempre que for indicada, os pais deveräo ser bem informados dos motivos da indicaçäo, das desvantagens, vantagens e possíveis complicaçöes. Por outro lado, a postectomia é um procedimento cirúrgico que exige técnica cuidadosa e asséptica, cujo principal cuidado é evitar danos ao pênis e assim deverá sempre ser executada por um cirurgiäo-pediátrico experiente, como qualquer outra operaçäo