1. What is prepuce?
This is the most common question mentioned by parents among male children. Prepuce refers to the narrow opening of the foreskin, and the foreskin cannot be turned up to reveal the glans. There are two types of prepuce: congenital and acquired. Congenital prepuce can be seen in every normal male newborn and infant. Most young boys between the ages of 3 and 4 have a foreskin that can be partially or completely turned up to partially or completely expose the glans. In this type of circumcision, there is scarring contracture at the foreskin opening, and the skin cannot expand due to loss of elasticity, so it is obvious during physical examination that the foreskin opening is stiff and white in a circular pattern, and thus the foreskin cannot be turned up. This situation will not heal on its own, and will be aggravated by repeated infections.
2.What are the dangers of circumcision?
The foreskin mouth of children with prepuce can be pinpointed, which can easily lead to inflammation of the foreskin and glans, and even cause ulcers on the foreskin and glans, which can cause narrow urethral opening due to inflammation. The foreskin can cause difficulty in urination, frequent urination, thin urine line, and bulging foreskin at the head end when urinating. Long-term difficulty in urination can even affect the form and function of the urinary tract. Another major hazard of prepuce is that it can also induce penile cancer, because the foreskin and glans of patients with prepuce are in a chronic irritating environment with or without bacterial infection for a long time, and there is a certain chance of being infected with human papilloma virus (HPV), which is currently recognized as one of the important factors causing penile cancer.
3.What are the bumps under the foreskin of children?
Circumcision tends to lead to the accumulation of a kind of foreskin scale that looks like a small white lump under the foreskin between the foreskin and the glans, which is often mistaken by parents for a tumor and is seen. This kind of foreskin scale is formed when urine accumulates in the foreskin sac and often irritates the foreskin and glans, stimulating it to produce secretions and epidermal shedding. Sometimes the foreskin scale can also be discharged in a milky tofu-like substance. In serious cases, foreskin scale can also induce the formation of inflammation and even cause ulcers on the foreskin and glans.
4. What are the symptoms of acute foreskin glansitis? How to treat?
When the acute attack of glans vulgaris occurs, it can be manifested by the redness and swelling of the foreskin and pain during urination. You can use a milder skin cleanser such as furacilin solution to give cleaning, generally 2 or 3 days after the glans penis can be significantly relieved. After the initial acute circumcision has healed, it is recommended that a follow-up visit to a pediatric urologist be made to determine if surgery is needed. Repeated circumcision can narrow the external urethral opening, causing obstruction to urination and can even lead to urinary tract infections.
5. What is circumcision stenosis?
In some children, the foreskin can be partially turned up, but you will see a clear narrowing ring in the turned-up foreskin. This narrowing of the foreskin can be improved by parents trying to turn the foreskin up every day through gentle manipulation, which may enlarge the foreskin opening, but should not be done too quickly to avoid painful upturning, foreskin splitting, bleeding, etc., which may cause fear of upturning in children and parents. On the other hand, if the foreskin is completely turned up, it should be returned in time, otherwise it may lead to the occurrence of imbedded prepuce due to the narrow ring pressing the local blood lymphatic return. Once the embedded prepuce occurs, it is manifested as edema of the upturned foreskin, the upper edge of the edematous foreskin is visible as an obvious narrow ring, the glans can be dark purple and swollen, the pain is more intense in children, if too long, the embedded foreskin and glans can become necrotic and fall off, therefore, the embedded prepuce should be consulted as soon as possible, most of them can be reset by hand, after successful reset, surgery should be performed at a later date, if the reset by hand fails, surgery should be performed urgently Treatment.
6.What is a long foreskin or foreskin adhesion?
The prepuce or foreskin adhesion is another common problem for children. Strictly speaking, it is a normal phenomenon for the prepuce to cover the glans before puberty. If the foreskin can be partially exposed by turning up the foreskin, most children do not have narrow foreskin or prepuce, but often the foreskin cannot be fully turned up because of adhesions between the foreskin and the glans. The same can be said for parents who try to turn the foreskin up every day through gentle manipulation, and as the adhesions gradually loosen, the glans can be fully exposed. The foreskin is too long refers to the foreskin in addition to covering the glans and penis, there is a significant excess of redundant skin, too long foreskin after urination there is a certain amount of urine residue, stimulating the formation of secretions, such as usually do not pay attention to cleaning, can also lead to repeated foreskin infection.
7.What kind of foreskin problems need surgical treatment?
An opinion published by the American Academy of Pediatric Work Professionals Group on Circumcision concluded that neonatal circumcision may offer some potential medical benefits. In particular, circumcision has the potential benefit of preventing urinary tract infections in those who are prone to them.
The need for the procedure depends largely on the decision of the child’s parents. Circumcision should be performed for the following conditions.
① Acquired circumcision with scar contracture at the foreskin opening.
(ii) Narrow foreskin opening, where the child is resistant to manipulation or where attempts at manipulation over a certain period of time are not effective.
(③) Recurrent inflammation, whether in cases of prepuce, narrow foreskin opening or circumcision, the above conditions may have an impact on the growth and development of the child’s penis or quality of life.
Surgery is recommended for the following cases.
① circumcision and narrowing of the foreskin opening after the age of 3 years.
② Those who have chronic urinary tract infections. The purpose of the surgery is to make the glans fully visible by removing the most distal part of the foreskin.
8.How to perform circumcision?
Circumcision can be performed by either circumcision or circumcision. The advantages of circumcision are no hospitalization, no stitches, no antibiotics, short operation time and short anesthesia. In foreign countries, special circumcision devices for newborn boys can be performed without even anesthesia. The instrument currently used in the Department of Pediatric Urology of Shanghai Children’s Hospital for circumcision surgery is the “Circumcision Special Instrument”, which has been awarded a national patent and has been successfully performed in nearly 10,000 circumcision surgeries. Generally, the ring will fall off automatically in about 2 weeks after the surgery, and the wound will heal naturally without scars caused by stitches, which is very popular among parents. Circumcision is similar to circumcision in mechanism, and the wound is generally closed with absorbable sutures, which heals in a week after surgery without removing stitches.
9.The same circumcision, why is the surgery different?
Circumcision is suitable for most cases of prepuce and circumcision. If the child has a certain risk of anesthesia such as combined asthma or severe allergy; or if the child’s penis has already started to develop and is prone to erection causing the circumcision to become embedded or fall off, circumcision should be avoided and circumcision should be performed and the child should be hospitalized for observation on the day of surgery. For inflammatory prepuce, if the degree of inflammation is not very serious, the scar narrow ring and excess foreskin can be removed by circumcision, but if the inflammation is more serious, it may lead to adhesions between the foreskin and glans or even the urethra, and the unhealthy tissue must be completely removed by fine surgical separation and trimming of the foreskin, otherwise it may cause sequelae such as recurrence of prepuce or even urethral stricture.
There is no such thing as the best time to treat this type of surgery. Depending on the severity of the prepuce and the attitude of the parents, etc., the surgery can be performed at an optional date.
10.What diseases are easily confused with simple prepuce or circumcision?
Occult penis is one of the more common external genital abnormalities in children, and parents often easily confuse it with prepuce or circumcision. Occult penis is a condition in which the penis is normally developed but is buried in subcutaneous fat due to obesity or excessive prepubic fat accumulation, resulting in the appearance of a short penis.
Another common abnormality of the external genitalia is hypospadias. In addition to the normal position of the urethra, the urethral opening in children with hypospadias may be located anywhere on the ventral side of the penis, in the scrotum or in the perineum, and may be combined with a downward curvature of the penis. In a typical child with hypospadias, the foreskin looks significantly different from that of a normal boy, failing to completely cover the glans and instead accumulating in a turban-like pattern on the dorsal side of the penis, with a V-shaped defect in the ventral foreskin and an absent foreskin tether. This type of hypospadias is easily detected by the abnormally positioned urethral opening and often promptly seeks medical attention. It is worth noting that some atypical hypospadias often manifests as a prepuce, and the abnormal urethral opening is only discovered when the foreskin is turned up and the glans is exposed. These cases are most common when circumcision or circumcision is performed, and once discovered, the surgery often needs to be suspended immediately for timely communication between the surgeon and the parents.
11.What should I do if my child has an occult penis?
If the foreskin can be turned up to fully reveal the glans, surgery is not necessary. The short appearance of the penis can improve to varying degrees with age, penile development or successful weight loss. If the circumcision is combined with phimosis, the circumcision or ring surgery should not be done, but should be corrected by a pediatric urologist through a specific circumcision surgery.
12.How to treat hypospadias?
The goal of treatment is to correct the downward curvature of the penis and to build a new urethra so that the child can have a satisfactory appearance of the penis and urethral opening, can stand and urinate like a normal person, and can have a normal sexual life as an adult. The construction of a new urethra requires sufficient foreskin tissue, and if the diagnosis and treatment of hypospadias are not sufficiently understood and atypical hypospadias is “mistakenly treated” as a prepuce and simply circumcised or circumcised, there may be a “lack of material” if further correction is needed. “This increases the difficulty of surgery and the chance of complications.
In conclusion, foreskin problems are a very common but complex problem, and parents who have questions about their children’s external genitalia should seek medical attention as soon as possible to have a professional pediatric urologist conduct a physical examination in person to determine the correct treatment plan. It is important not to think that the problem is not serious or to seek medical help in an emergency, as this may delay the diagnosis and treatment of the child or bring unnecessary pain and psychological burden to the child.