Phimosis in Children: Treatment Options and Concerns

Q: Phimosis in Children: Treatment Options and Concerns

A-Kai： Hello, in general, circumcision should only be performed if there are severe issues, such as affecting penile development or frequent infections. <br>Otherwise, I would recommend waiting until after puberty for the surgery. <br>The reasons are： 1. <br>After puberty, the pe

Phimosis in a 4th-grade student?

My child is currently in the fourth grade, and during a recent school health check, it was reported that he has phimosis.
After visiting the hospital for further examination, it was confirmed that he has phimosis and requires a circumcision under general anesthesia.
Are there any other methods to address this condition? Also, what is the best age to perform the surgery? I understand that my child is still in the developmental stage, and I am concerned about the possibility of having a short penile shaft after circumcision.
Would the use of topical steroids be helpful in this situation?

A-Kai, 30~39 year old female. Ask Date: 2015/12/08

Dr. Xu Weikai reply Urology

A-Kai: Hello, in general, circumcision should only be performed if there are severe issues, such as affecting penile development or frequent infections.
Otherwise, I would recommend waiting until after puberty for the surgery.
The reasons are: 1.
After puberty, the penis has developed, allowing for a more accurate determination of its size, which helps in deciding how much foreskin to remove, thus avoiding the need for a second procedure later on.
2.
Typically, after puberty, children can undergo the procedure with local anesthesia, which allows for better cooperation, resulting in lower costs and higher safety.
As for medication, topical steroids can be effective for some children, but it requires patience.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only be used as a reference; if necessary, it is important to seek medical attention at a healthcare facility.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2015/12/08

More Info

Phimosis is a condition where the foreskin of the penis cannot be easily retracted over the glans (the head of the penis). This condition is relatively common in children, especially in those who are prepubescent. In many cases, phimosis resolves naturally as the child grows and the foreskin becomes more pliable. However, when it persists and causes issues such as pain, difficulty urinating, or recurrent infections, medical intervention may be necessary.

In your case, it seems that your child has been diagnosed with phimosis, and the recommendation is for a circumcision procedure under general anesthesia. While circumcision is a definitive treatment for phimosis, it is understandable to have concerns about the necessity of surgery, especially considering your child's age and ongoing development.

Non-Surgical Treatment Options
Before proceeding with surgery, there are non-surgical options that may be considered:
1. Topical Steroid Creams: Applying a topical steroid cream, such as betamethasone, can help to soften the foreskin and make it easier to retract. This treatment is often effective and can be used for several weeks to see if it alleviates the condition.

2. Gentle Stretching Exercises: Parents can be instructed on how to gently stretch the foreskin over time. This should be done carefully and without force to avoid pain or injury. Regular, gentle retraction during bathing can help in some cases.

3. Observation: If the phimosis is not causing any symptoms, some healthcare providers may recommend a watchful waiting approach, as many children outgrow the condition without intervention.

When to Consider Surgery
Circumcision is typically recommended when:
- The child experiences pain or discomfort.

- There are recurrent infections or inflammation (balanitis).

- The phimosis is causing urinary obstruction.

As for the timing of the surgery, many pediatric urologists suggest that circumcision can be performed safely at any age, but it is often done before the child reaches puberty. Performing the surgery at a younger age can reduce the psychological impact and the potential for complications associated with the procedure.

Concerns About Shortened Foreskin
Your concern about the possibility of having a "too short" foreskin after circumcision is valid. However, circumcision typically involves the removal of the foreskin entirely, so this concern is less applicable. If the procedure is performed correctly, it should not result in complications related to the length of the remaining skin.

Conclusion
In conclusion, while circumcision is a common and effective treatment for phimosis, it is essential to consider non-surgical options first, especially if the condition is not causing significant problems. Consulting with a pediatric urologist can provide you with a comprehensive understanding of the best course of action for your child. They can help you weigh the risks and benefits of surgery versus conservative management and guide you through the decision-making process. Always ensure that any treatment plan is tailored to your child's specific needs and circumstances.

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