Circumcision and disorders of penis
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Paraphimosis is rare and is characterised by oedema and swelling of the distal penis. It is due to retraction of a tight preputial ring proximal to the coronal sulcus. Circumcision may be necessary when this is severe or recurrent in nature. Relative indications for circumcision include prevention of penile and cervical cancer, prevention of sexually transmitted disease (particularly HIV/AIDS), and the prevention of UTI. Published reports from sub-Saharan African countries have shown that circumcision can reduce the risk of HIV acquisition by reducing the ability of the virus to attach to and enter the Langerhans’s cells that are present in high density in the inner layer of the foreskin. The susceptibility of the foreskin to trauma may predispose to HIV infection during sexual activity. A systematic review summarising studies from sub-Saharan Africa, has shown an adjusted relative risk of HIV acquisition of 0.42 (95% confidence interval) in circumcised compared with uncircumcised male subjects.
Male genital anomalies
Prem Puri in Newborn Surgery, 2017
Circumcision should prevent phimosis, paraphimosis, and balanitis, although good population studies proving this are hard to find. Learman10 concluded that the evidence supporting circumcision was too weak to recommend routine operation. Urinary tract infection in neonatal males can be reduced by circumcision from 7/1000 to 1.9/1000,11 but whether improved penile hygiene would have the same effect is unknown. STD rates in circumcised men are 10% lower than without circumcision, when comparing men presenting to an STD clinic in a Western country.12 In sub-Saharan Africa, the benefits of circumcision in reducing HIV risk may be much greater,13 although meta-analysis has not confirmed a benefit.14,15 Circumcision is linked with a threefold reduction in penile cancer, although the low frequency of the condition does not justify routine neonatal operation. Learman10 estimated that over 300,000 circumcisions were required to prevent one penile cancer/year. In Denmark, the incidence of penile cancer has fallen, despite no increase in circumcision, suggesting that other factors such as hygiene are important.16
Neonatal and General paediatric Surgery
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
Pathological phimosis rarely occurs before the age of 6 years. The foreskin is scarred and whitish in appearance and the opening is severely narrowed resulting in non-retractability (Fig. 18.80). During micturition there may be ballooning of the foreskin and dribbling may occur after voiding. Following an erection, the narrowed foreskin may remain around the glans, constricting its blood supply and culminate in a paraphimosis. The paraphimosis is an extremely painful swelling of the glans that requires emergency treatment either in reduction of the foreskin or a dorsal slit if reduction is not possible.
An evaluation of the pharmacotherapeutic options for the treatment of adult phimosis. A systematic review of the evidence
Published in Expert Opinion on Pharmacotherapy, 2022
Anna Lygas, Hrishikesh Bhaskar Joshi
Some indications to proceed with active treatment, in children, are recurrent urinary tract infections (UTIs), balanoposthitis and paraphimosis. Historically, the mainstream treatment of phimosis in children was surgery in a form of either circumcision or preputioplasty. The surgery caries number of risks and complications including local infection, hemorrhage, meatitis, and ulceration. For that reason, conservative treatment options have been explored as alternative to surgery.
Related Knowledge Centers
- Cystoscopy
- Edema
- Glans Penis
- Phimosis
- Foley Catheter
- Gangrene
- Foreskin
- Medical Emergency
- Medical Error
- Urinary Catheterization