Phimosis

Abstract

Most of newborn boys shows the true phimosis, and tight physiological adhesions between the foreskin and glans gradually disappear, and then the foreskin can be turned over at the age of 3-4 years (Kayaba et al. J Urol. 1996;156:1813-5). In some countries circumcision is sometimes carried out on newborns for the religious or traditional reasons; however, circumcision is not usually carried out on young infant in Japan. Many doctors agree that the complete exposure of the glans is not necessary in infant boys in Japan. The indications for the surgical treatment in phimosis are balanitis xerotica obliterans, recurrent foreskin balanitis, urinary infection risk due to the balloon-like swelling of the foreskin (ballooning), incarcerated phimosis, and the redundant foreskin in puberty, although conservative treatment with steroid ointment has reduced the surgical treatment for phimosis (Sumitomo et al. Jpn J Pediatr. 2011;64:1158-63). Either dorsal incision or circumcision has been performed as fundamental procedures for pediatric phimosis. However, recently triple incision is widely performed as a simple and convenient method (Wahlin Scand J Urol.1992;26:107-10). In this method the foreskin is preserved as much as possible depending on the idea that the glans is not always to be exposed in young children. Except for urgent stenosis in incarcerated cases, dorsal incision procedure is not performed, because the foreskin shows ugly sag "dog ear" after surgery. The triple incision procedure, the circumcision, and dorsal incision are described here.