Prepuce, defined as the foreskin covering the external urethral opening and not being able to turn over on its own to the coronal sulcus.
The definitive book on urology, Campbell’s Urology, 8th edition, page 2334, on pediatric prepuce translates as follows: At birth, most infants have physiologic prepuce, or a foreskin that cannot be turned up. This is due to an innate adhesion between the foreskin and the glans. At the age of 3-4, as the penis grows and develops, a lot of epithelial debris (prepuce) accumulates under the foreskin, gradually separating the foreskin from the glans. Intermittent penile erection allows the foreskin to become fully turned up. By the age of 3 years, 90% of children can turn their foreskin up, whereas by the age of 17 years less than 1% of males have a prepuce ([88] Oster, 1968).
Forcing the foreskin up at an early age is undesirable because violent trauma can re-adhere the glans to the foreskin and scar the anterior aspect of the foreskin, leading to secondary prepuce. However, in boys older than 4 to 5 years of age or those who have had glans and glans prepuce, a corticosteroid ointment (e.g., 0.1% dexamethasone ointment) applied to the foreskin three to four times daily will loosen the ring of the foreskin in two-thirds of affected children after 6 weeks of use and will allow the foreskin to be turned up by hand ([84] Monsour et al, 1999).
Topical corticosteroid ointment is beneficial even if the child has a combination of dry glansitis. Formal release of foreskin adhesions is rarely applied. Circumcision or dorsal circumcision of the foreskin should be considered for children over 7 to 8 years of age whose prepuce has failed to respond to local medication, for children whose foreskin swells up during urination, and for children with recurrent glansitis.
In China, pediatric surgery currently considers that only “scarring prepuce” is an absolute surgical indication for prepuce within 5 years of age, while most other non-surgical treatments, such as gauze peeling, vascular clamp expansion, balloon expansion, etc., are used to apply ointment after performing foreskin peeling; for the treatment of pediatric prepuce above 5 years of age, circumcision is traditionally used.
For those pediatric patients without any symptoms of prepuce, they can be completely observed and treated to avoid circumcision and keep the penis of the pediatric patient clean and hygienic. Most of the children can recover or develop normally when they grow up. If the child is still circumcised when he or she reaches adulthood, circumcision is also possible. Avoiding foreskin inflammation and preventing foreskin adhesions are key.