Currently, foreskin and prepuce have been listed as a physical examination item for kindergarten and elementary school entrance, just to avoid inflammation and other conditions that can affect learning after entering school. Although circumcision is small, the impact is determined, therefore, many parents overlook a situation, the impact of this surgery is lifelong and extremely important. A few minutes of surgery, whether it can be done perfectly or not, will affect the lifelong happiness of your little one, so please do not take it lightly!
1.Overview
Circumcision is a condition where the foreskin covers the urethral opening but can be turned up to reveal the urethral opening and the head of the penis, but is often accompanied by a prepuce.
Circumcision refers to the narrow foreskin mouth, so that the foreskin can not be turned over to reveal the head of the penis.
2.Classification.
Circumcision can be divided into true circumcision and pseudo-circumcision. True circumcision is the penis erection after the glans can not be completely exposed; pseudo-circumcision refers to the usual glans can not be completely exposed, but after the penis erection glans can be completely exposed.
There are two kinds of circumcision: congenital and acquired. Congenital prepuce, also known as physiological prepuce, is found in almost every normal newborn and infant. When a child is born, the foreskin opening is small but the skin is normal and elastic, and the foreskin is attached to the head of the penis. Generally after 3 to 4 years of age, due to the growth of the penis and the head of the penis, the foreskin can mostly retreat upward by itself, and the foreskin can be turned out to reveal the head of the penis.
Some children’s foreskin mouth is very small, so that the foreskin can not retreat, and sometimes the foreskin mouth is as small as a pinhole, so that urination difficulties occur, and even secondary vesicoureteral reflux. Children with prepuce, due to the accumulation of secretions under the foreskin, often irritate the mucous membrane, can cause the head of the penis foreskin inflammation. Acquired prepuce, also known as pathological prepuce, is mostly secondary to penile head prepuce and injury to the foreskin and penile head.
The incidence is about 0.8% to l.5%. Acute penile head circumcision, repeated infections, gradual scarring of the foreskin mouth and loss of elasticity, scarring contracture formation of the foreskin mouth, loss of skin elasticity and expansion ability, foreskin can not retreat upward, and often accompanied by urethral stenosis. This kind of prepuce will not heal by itself.
3.Diagnosis
If the foreskin is wrapped around the glans, but the glans can be exposed when the hand is turned over, the foreskin is circumcised.
If the foreskin is wrapped around the glans and the glans cannot be exposed when the hand is turned, it is prepuce, which can be combined with symptoms: difficulty in urination, thin urine line and foreskin puffing up when urinating if the foreskin opening is narrow. Long-term difficulty in urination can cause complications such as prolapse, and even vesicoureteral reflux and hydronephrosis. Urine retention in the foreskin sac often stimulates the foreskin and penile head, prompting it to produce secretions and epidermal shedding, forming excessive foreskin scale.
In serious cases, it can cause ulcers or stones to form on the foreskin and head of the penis. The accumulated foreskin scale is milky tofu-like, discharged from the tiny foreskin mouth. Some of the foreskin scale is as big as a soybean, and it accumulates at the coronal groove of the head of the penis, and a small, slightly white lump is visible through the foreskin, which is often mistaken for a tumor by parents. As the foreskin scale accumulates under the foreskin, it can induce foreskin inflammation of the head of the penis. In acute inflammation, the head of the penis and foreskin are moist and red, and a purulent discharge can be produced. The skin elasticity of the foreskin mouth and the presence of scarring should be noted during the examination to distinguish between physiological and pathological prepuce.
4.Hazards of paediatric overcircumcision and prepuce
(1) too long foreskin, often completely cover the urethral orifice, so that urination is not complete, there is often a small amount of urine residue in the foreskin cavity, coupled with young children wearing crotch pants, the foreskin mouth and urethral orifice is often contaminated by the outside world, the foreskin and urethral orifice is very easy to inflammatory adhesion, aggravating the difficulty of urination. Such children struggle to urinate each time, the foreskin cavity swells, often with prepuce cavity stones, urinary tract infections and other serious complications.
(2) foreskin will affect the growth and development of the penis, in adolescence because the head of the penis is tightly wrapped by the foreskin, do not get due stimulation from the outside world, the development of the head of the penis is greatly constrained, resulting in the development of mature sex organs, the circumference of the crown of the penis is significantly smaller, resulting in children depression, low self-esteem and other adverse psychological disorders.
(3) There are abundant sebaceous glands in the foreskin, which can secrete a large amount of sebum. When the foreskin is too long, the secretions of the sebaceous glands in the foreskin cannot be discharged, and the sebum and urine precipitates are synthesized into the cheese-like and smelly “foreskin scale”. The foreskin scale is suitable for bacterial growth, so it can cause inflammation of the penis head and foreskin. The germs can also cause urinary tract infections through the urethra. The inflammation that occurs in the urethra can cause the urethra to narrow after healing, causing difficulty in urination.
5.Treatment
The foreskin and the head of the penis in newborns are adherent and there is usually no need to separate these adhesions. If the parents of a baby boy do not request a neonatal circumcision (cut), it is not necessary to examine the head of the penis. Head of penis foreskin adhesions are usually separated at age 4 years, but some are later. If there is no penile head infection or urinary tract infection, there is no need to turn the foreskin and it can be left to separate on its own. Children who do have inflammation or infection of the foreskin or head of the penis may have the inner foreskin plate separated.
Generally, circumcision can be done for children over 4 years old. The surgical method is mainly circumcision, which is short, less painful and has a beautiful postoperative wound. Anesthesia is mainly local anesthesia and inhalation general anesthesia + local anesthesia. At present, because children are prone to crying and struggling due to pain and fear during surgery under local anesthesia, they often need to be tied up after the surgery, which may lead to trauma to the child’s mind and unsatisfactory surgical results. With the current anesthesia technology, as long as the perfect preoperative preparation, inhalation general anesthesia + local anesthesia will not have the side effects of anesthesia that parents are worried about.
6.Prevention and treatment of postoperative complications
(1) Infection: routine postoperative antibiotics and topical medication for prevention.
(2) Bleeding: Mostly caused by poor intraoperative vascular ligation or loosening of the ring sleeve, pressure can be added or reoperation to stop bleeding.
(3) Foreskin mouth narrowing: mostly caused by surgical scar or intraoperative failure to remove more than the narrow ring.
(4) Short foreskin: Mostly caused by excessive surgical removal of foreskin.