Prepuce refers to a state in which the foreskin cannot be turned up above the coronal sulcus, so that the head of the penis cannot be fully exposed.
Classification of prepuce: It is divided into 2 categories, namely congenital (physiological) and secondary (pathological). After about 3~4 years old, physiological prepuce can mostly heal itself (about 90%, I think).
Secondary prepuce, also called pathological prepuce, is mostly caused by injury or infection of the foreskin and the head of the penis, and the foreskin mouth forms scars, degeneration, and sclerosis – the foreskin cannot be turned up and often cannot heal on its own. In severe cases, difficulty in urination or even urinary retention may occur. Long-term inflammatory stimulation can increase the incidence of penile cancer. It is worth mentioning that patients with diabetes are prone to recurrent episodes of glans penis and pathological prepuce. Therefore, diabetic patients need to pay special attention to, first, control blood sugar, second, maintain local hygiene, and third, seek medical attention as soon as local abnormalities are detected.
Clinically, prepuce can manifest as foreskin scale accumulation, infection, abnormal urination, penile cancer, sexual dysfunction, prepuce impaction, etc.
Meuli grading: divided into IV grade I, the foreskin can be completely turned up to the coronary sulcus, with only an axial narrow ring; grade II, the foreskin can be partially turned up, revealing part of the penis head; grade III, the foreskin can be partially turned up, revealing only the urethral opening; grade IV, the foreskin cannot be turned up at all.
In addition, there is the Kikiro classification (grade 6), which is difficult for laymen to understand and will not be discussed here.
With regard to treatment, there are several different methods for different conditions: 1. Wait and see, for asymptomatic children <2 years old with physiological prepuce. 2.Medication, mainly applied with steroid cream, for children with pure physiological prepuce or complications of glansitis; 3.Foreskin opening expansion, for children with physiological prepuce, 3 years old or older. 4.Manipulation flip or reset, target: patients with foreskin impaction or physiological prepuce, children above 3 years old. 5.Surgical treatment, circumcision, target: pathological prepuce, physiological prepuce combined with recurrent glansitis, recurrent urinary tract infection, etc. 6.Circumcision, target: those who request not to remove the foreskin (I personally think this method is not a better choice for many patients with prepuce). 7, the safety of surgery: in general, the surgery is safe, very few patients have prolonged wound healing time, bleeding, infection, pain. Simple understanding: pediatric prepuce more without surgery, adult prepuce more need surgery, specific analysis, such as the discovery of prepuce or recommend hospital consultation.