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Paediatric Surgery
Phimosis and Buried Penis
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 64 slides
The Normal Foreskin
What it is, what it does, and how it grows
- What are we actually talking about?
- What is the foreskin for?
- How the foreskin is built, before birth
- How foreskin and glans come apart: keratinization
- Why a newborn's foreskin will not pull back
- The foreskin frees itself over childhood
- Non-retractable foreskin falls with age (Gairdner)
- Smegma and 'smegma pearls'
When a Normal Foreskin Misbehaves
Balanoposthitis and paraphimosis
- Inflammation of the tip: balanoposthitis
- Balanoposthitis: causes and how it looks
- Balanoposthitis: how it is managed
- Paraphimosis with a swollen, trapped foreskin
- Paraphimosis: a foreskin stuck in the back position
- Paraphimosis: putting it right
Congenital and Acquired Conditions
Fusion anomalies, trauma, and true scarring
- When penis and scrotum fail to separate
- Webbed penis: scrotal skin fused along the shaft
- The simplest form: webbed penis
- Buried penis hidden by fusion and abnormal tethering
- A more severe form: buried penis
- The megaprepuce variant
- Why simple circumcision is the wrong operation here
- How buried penis is surgically corrected
- Newer techniques for buried penis
- Penile and foreskin trauma
- BXO: a scarred, white foreskin tip
- True phimosis: Balanitis Xerotica Obliterans (BXO)
- BXO: how it presents
- BXO: what it is and where it comes from
- BXO: treatment and the meatal stenosis link
Should the Foreskin Be Removed?
Indications, controversy, and evidence
- Why most circumcisions are actually done
- When circumcision must NOT be done
- Does routine circumcision actually prevent problems?
- The urinary tract infection (UTI) argument
- Doing the maths: how many operations per UTI prevented?
- Where the numbers DO justify circumcision
- Phimosis is over-diagnosed
- Sorting out the indications
How Circumcision Is Done
Clamps, devices, and freehand techniques
- The goal of a good circumcision
- Two newborn clamp devices
- The Mogen clamp for ritual circumcision
- Circumcision in older children
- The freehand technique, step by step
- The sleeve technique, step by step
Complications of Circumcision
Early problems, meatal stenosis, and the data
- Complications: the historical and modern picture
- Early complications and meatal stenosis
- Reported complication rates across six surgical series
- Why the complication figures vary so wildly
- Why does a newborn's foreskin normally fail to retract, and why must you not force it?
Summary and Key Points
What to carry away
- The big ideas of this chapter
- Numbers worth remembering
- References (1/5)
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- References (5/5)
- Pediatric Surgery and Pediatric Urology