Acquired phimosis after plastibell circumcision: a preventable consequence.

INTRODUCTION: The plastibell device is used successfully for religious and cultural circumcisions in the community. The aim of this article is to highlight the recognition and management of iatrogenic phimosis. METHODS: A retrospective study was performed of outcomes of plastibell circumcision in a community-based circumcision service provided by trained paediatric surgeons. The objective was to assess the complication of slipped plastibell rings and to ascertain the effectiveness of its management. RESULTS: A total of 5 patients with a slipped plastibell ring were indentified out of 560 plastibell circumcisions. Three patients presented with acquired phimosis. In two patients early diagnosis and management prevented any further complications and a second operation was avoided. CONCLUSIONS: Plastibell circumcision in the community is safe and effective. Detection of minor bleeding due to a slipped ring is important. Early management can avoid the risk of acquired phimosis due to cicatrix formation and can save parents of undue anxiety.

[Phimosis]. / Phimose.

Phimosis is a common condition in which the foreskin cannot be retracted over the glans penis. First appearing at 8 weeks gestation as a ridge of thickened epithelium, the prepuce grows forward over the developing glans. Physiological phimosis is common in male patients up to 3 years of age. Balanoposthitis is an inflammation of the foreskin and glans and occurs in 4-11% of uncircumcised boys. Lack of circumcision has been identified as a risk factor for urinary tract infection in infants as well as several sexually transmitted diseases and penile cancer in adults. Local steroid application showed satisfactory success rates of more than 80% and is recommended as first choice therapy. Male circumcision carried out under the age of 14 years without medical indications is unlawful and classified as bodily harm under German law.

[Circumcision in Nesbit corporoplasty: a mandatory time? Our experience on 158 patients]. / La circoncisione nella corporoplastica secondo Nesbit: tempo obbligatorio? Esperienza su 158 pazienti.

INTRODUCTION: The Nesbit procedure is the most common surgical technique to correct congenital or acquired penile curvature. It is a common opinion that this surgical procedure has to be completed with a circumcision to prevent foreskin necrosis or phimosis. According to our experience we believe that some procedural "tricks" could strongly reduce that mechanical and ischemic trauma on the foreskin responsible for these complications. MATERIALS AND METHODS: From 1988 to 2010 we selected 158 patients treated with Nesbit's corporoplasty. The procedure was recommended to patients who presented a penile curvature wider than 30° and reporting however some difficulty or pain at coitus, or to patients who complained about aesthetical problems (123 patients presented a La Peyronie disease and 35 presented a congenital curvature). RESULTS: Eleven patients underwent circumcision during surgery because of a pre-operative phimosis, or according to their own desire. Among the patients who did not undergo circumcision (147), paraphimosis was present in 3 patients. We reported only one case of curvature recurrence in a patient who had a sexual intercourse the day after surgery. We also had one case of hourglass effect in a congenital curvature. DISCUSSION: We believe that some tricks during Nesbit surgical procedure could prevent tissue and vascular trauma that give rise to tissue retraction, and consequently to phimosis and foreskin necrosis: a coronal incision to 0.5-1cm from the gland line would allow to let intact an adequate amount of reflection of skin (prepuce) bound of preputial skin reflection , maintaining good vascularity. The careful degloving with preparatory isolation of the dissection plan between dartos and Buck's fascia, can reduce vascular trauma of the fascia, minimizing bleeding and ensuring tissue vitality. Moreover, execution of only two hydraulics erections, after degloving and after correction, causes a minimal tissue stress. CONCLUSIONS: Circumcision must not be considered a mandatory time in Nesbit procedure: on the contrary, mandatory is the respect of the anatomical structures surgically attacked to avoid preputial resection.

[Analysis of treatment results of boys referred to outpatient paediatric surgery centre with recognition of phimosis]. / Analiza i ocena wyników leczenia chlopców kierowanych do poradni chirurgii dzieciecej z powodu trudnosci w odprowadzeniu napletka.

UNLABELLED: The problem with prepuce retraction is caused not only by its narrowing, called phimosis, but also frequently by the inner prepuce adhesion to glans. The spontaneous prepuce retraction is received in 80% cases of boys up to the age of two, whereas in remaining cases, after the age of two it is necessary to take up the medical treatment. The purpose of the research was to estimate the effectiveness of conservative therapy using steroid ointments which was undertaken in boys referred to Outpatient Paediatric Surgery Centre with recognition of phimosis. MATERIAL AND METHODS: Cases of 315 boys referred to Outpatient Paediatric Surgery Centre due to phimosis were analyzed between April 2004 and May 2007. At the first appointment the boys were divided into 3 main groups: I--children with foreskin adhesion without visible stenosis (near 20%), who had the prepuce adhesion released in a local anaesthetic with Emla cream; II--children with narrowed foreskin (phimosis) who were treated with the use of conservative therapy by means of topical steroids (about 70%); III--children with stenosed prepuce (phimosis) developed to a large extent, who were immediately qualified to a surgery therapy without trying the conservative therapy (near 10%). RESULTS: Among all patients about 1/5 needed the prepuce adhesion releasing with the use of Emla ointment only. High efficiency of conservative treatment with topical steroids was revealed both in primary and acquired phimosis. Reduction of the therapy time of children treated with topical steroids because of primary phimosis in relation to those treated surgically was taken into account. CONCLUSION: Conservative treatment of phimosis is highly effective and safe method which may also be an initial stage to operative treatment or to cure scarring after surgical treatment as well.

Circumcidar preventivament o no. Pros i contres / Circuncidar preventivamente o no. Pros y contras / Pros and cons of prophylactic circumcision

Fonament. El maneig de la fimosi pediàtrica continua essent un tema a debatre. Objectiu. Revisar la literatura sobre fimosi per determinar si la circumcisió preventiva és o no és necessària. Mètode. Recerca bibliogràfica a partir de bases de dades informàtiques (TRIP, Cochrane, PUBMED). Resultats i conclusió. La revisió de la literatura indica que caldria conèixer l’impacte global (morbiditat + estudis cost-efectivitat) de la circumcisió sobre les infeccions d’orina i les seves repercussions, per poder establir amb seguretat la necessitat o no de circumcidar preventivament (AU)

Fundamento. El manejo de la fimosis pediátrica sigue siendo un tema a debate. Objectivo. Revisar la literatura sobre fimosis para determinar si la circuncisión preventiva es o no es necesaria. Método. Búsqueda bibliográfica a partir de bases de datos informáticas (TRIP, Cochrane, PUBMED). Resultados y Conclusión. La revisión de la literatura indica que es necesario conocer el impacto global (morbilidad + estudios coste-efectividad) de la circuncisión sobre las infecciones de orina y sus repercusiones, para poder establecer con seguridad la necesidad o no de circuncidar preventivamente (AU)

Background. The management of phimosis in children is still controversial. Objective. To review the literature regarding phimosis in order to determine whether prophylactic circumcision is indicated. Methods. Bibliographical research using informatic databases (TRIP, Cochrane, PUBMED). Results and conclusion. Our review of the literature indicates that, in order the establish the value of prophylactic circumcision, it would be necessary to evaluate the overall impact (morbidity and cost-effectivity studies) of circumcision in the incidence of urinary tract infections and its repercussion (AU)

Fimosis y circuncisión

La circuncisión es la intervención quirúrgica más antigua conocida por el hombre; su técnica libera tejido prepucial cicatrizal fibroso que disminuye la abertura prepucial y exposición normal del glande, patología conocida como fimosis. Tanto el prepucio como el glande conservan un epitelio común que se separa y queratiniza gradualmente, fénomeno que concluye normalmente al final de la gestación y en la adolescencia, hecho que logra completarse en el 4 por ciento de recién nacidos. El 90 por ciento de niños presentan adherencias del prepucio que generalmente desaparecen antes de los 17 años y tan sólo el 2-5 por ciento de los niños presentan una fimosis verdadera y requieren de circuncisión...

Routine neonatal circumcision?

Routine neonatal circumcision is still a controversial procedure. This article attempts to clarify some of the advantages and disadvantages of neonatal circumcision. The increased rate of penile cancer among uncircumcised men appears to justify the procedure, but that alone is not sufficient justification. The final decision on neonatal circumcision should be made by parents with balanced counsel from attending physicians.

Neonatal circumcision.

The American Academy of Pediatrics has stated that there is no valid medical reason for performing routine neonatal circumcision. Although the issue is hotly debated in medical circles, little attention has been given to the issue in the nursing literature. It is important that nurses understand the medical, social, religious, and child care issues involved in order to help parents make informed decisions regarding circumcision of their neonate.