I. Physiological prepuce
Most newborns are often accompanied by the relative narrowing of the foreskin mouth, so that the foreskin can not be flipped to reveal the head of the penis, that is, physiological prepuce only 4% of newborns can be completely flipped 3-4 years old due to the growth of the penis and the head of the penis and the gradual accumulation of epithelial debris under the foreskin, coupled with intermittent erection of the penis, the foreskin gradually expanded, the foreskin can be self-receding upward, the foreskin can be easily revealed glans at the age of 3 about 90% After the age of 17, only less than 1% of the circumcision heals itself.
Second, acquired prepuce
Mostly secondary to: forcible upturning of foreskin, tearing of foreskin mouth, scar healing, recurrent foreskin inflammation caused by diaper rash, penile head circumcision, foreskin and penile head injury; after circumcision, residual ring-shaped scar formation and adhesion with penile head.
Third, the foreskin is too long
The head of the penis is completely covered by the foreskin, but the head of the penis can be revealed by turning up the foreskin, the paediatric circumcision can be self-healing
Four, foreskin scale
Foreskin scale is caused by the gradual accumulation of epithelial debris under the foreskin. The circumcised children due to urine accumulation in the foreskin sac, often stimulate the foreskin and penis head, prompting it to produce white secretions and epidermis off, forming too much foreskin scale. The accumulated foreskin scale is milky white beanbag-like, some like soybean grain size, piled up in the coronal groove of the head of the penis, across the foreskin slightly white small lumps, mistaken by parents for swelling, and the doctor.
Five, glans foreskin inflammation
Commonly seen in boys aged 2-5 years whose foreskin cannot be turned up.
Incidence: occurs in 4% of boys who are not circumcised.
Etiology: unclear (infection, trauma, contact irritation, contact allergy, etc.)
Manifestations: redness and swelling of the penile head and foreskin, purulent discharge, pain and uneasiness in the child, edema of the foreskin, difficulty in urination, and in rare cases, acute urinary retention. If combined with urinary tract infection, painful urination may occur, requiring routine urinalysis of the middle urine and oral antibiotics if the urinary WCB is elevated.
Most priapism is a self-limiting disease, and simple prepuce does not require oral antibiotics.
Sixth, embedded prepuce
Ingrown prepuce is a complication of prepuce and circumcision. When the foreskin is turned over the head of the penis, it fails to reset in time, resulting in imbedded prepuce.
The edematous foreskin is turned over the coronal groove of the head of the penis, and a narrow ring is visible at the upper edge of the edematous foreskin. The head of the penis is dark purple and enlarged. The child has severe pain and may have difficulty in urination. If the time is too long, the embedded foreskin and the head of the penis may become necrotic and fall off
Treatment: Manual repositioning, if the manual repositioning fails, dorsal circumcision is performed.
Whether pediatric prepuce needs early upward foreskin treatment.
It is not advocated to forcibly flip the foreskin too early to avoid re-adhesion and foreskin injury leading to secondary prepuce. For physiological prepuce in children over 3 years old, the foreskin can be turned up repeatedly on a trial basis to expand the foreskin opening. Most children can be cured with age after such treatment.
Indications for circumcision surgery in children.
1, fibrous narrow ring at the foreskin opening.
2. recurrent episodes of circumcision of the penile head.
3, narrow foreskin mouth after the age of 5 years, the foreskin still can not retract and reveal the head of the penis after a trial manipulation flip.
4, adult prepuce, the penis in erection r still can not reveal the glans.
5.Circumcision with vesicoureteral reflux and repeated urinary tract infection.
Pediatric circumcision surgery time
Generally speaking, circumcision should be considered only after puberty, when the patient does not need general anesthesia.
However, if a young boy has recurrent circumcision or even urinary tract infections due to overcircumcision or circumcision, early surgery should be performed to circumcise the foreskin.
For inflammatory prepuce caused by recurrent circumcision or rupture of the foreskin opening, circumcision needs to be performed as soon as possible.