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PubMedDate not supplied

[Circumcision--criticism of the routine].

Circumcision is one of the most frequent operative procedures done in males. About 120 circumcisions are performed every 5 minutes over the world [14]. Three different reasons lead to circumcision: 1) Medical reasons in present of a pathologic phimosis. 2) Circumcisions done due to religious, social or cultural rea-reasons. 3) Finally in many countries circumcision is performed as "routine-circumcision" in the newborn period. While in the United States the number of routine-circumcisions decreases (about 60% of all male newborns) South-Korea has a rate near to 100%. Even with no religious or cultural background in Germany circumcision often is performed without scrutinizing medical indication. Circumcision is regarded as an procedure with no complications and no disadvantage for the patient. In general circumcision has no medical benefit neither in decreasing the incidence of urinary tract infections nor of sexual transmitted diseases nor of neoplasias. Medical indication for circumcision is given in present of pathologic phimosis in 4% of all males. Postoperative complications range up to 2% and "circumcision is the amputation of the prepuce from the rest of the penis, resulting in permanent alteration of the anatomy, histology and function of the penis...". There are many reports about having discomfort and disadvantages after circumcision as well to the males as to the sexual partners. This challenge the legality of neonatal involuntary circumcision because legality is based on saving the children's best interests.

Circumcision, Male↗
PubMed1995

CO2 laser for therapeutic circumcision in adults.

The use of carbon dioxide laser for 38 posthetomies or therapeutic circumcisions in the treatment of phimosis, paraphimosis, balanitis of Zoon or a genital infection by the human papillomaviurs permits clean and hemostatic incisions. The clean and dry wound produced by the carbon dioxide beam offers several advantages. It reduces the surgeon's risk of contamination by the HIV virus and the subsequent sear is regular and without edema. In 57% of primary phimosis cases, the histological analysis showed a lichen sclerosus et atrophicus.

Adult↗
PubMed2003

Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons.

To assess the reasons for and outcomes of referrals concerning the foreskin, 100 consecutive patients seen in paediatric clinics were followed to discharge. 18 referrals were for circumcision on religious grounds. Of the other 82, the main reason for referral was non-retractability or phimosis. At clinic, 24 (29%) of these were deemed normal for age, 31 (38%) were treated with topical steroid (successfully in 25), 9 (11%) were listed for preputioplasty, 7 (9%) were listed for adhesiolysis, 7 (9%) were listed for circumcision, and 4 were listed for other forms of surgery. 6 patients were identified as having balanitis xerotica obliterans (BXO), a condition that had not been suggested on referral. With the advent of new treatments for foreskin disorders, circumcision is decreasingly necessary. Knowledge of the natural history of the foreskin, and the use of topical steroids, could shift the management of paediatric foreskin problems from the hospital outpatient department to primary care. BXO is not sufficiently recognized as a form of phimosis that requires operation.

Administration, Topical↗
PubMed1951

The pros and cons of routine circumcision.

The origin of the practice of circumcision is an ancient one having a ritual significance in most cases, but the operation is done primarily for hygienic purposes amongst English-speaking people. Critical evaluation of the indication for circumcision suggests that the hygienic principles are probably overrated. If it were understood that the anatomy of the prepuce and glans has a morphological development which in most cases removes the possibility of phimosis after the third year, less emphasis would be placed on the necessity for the operation. On the other hand, the feeling exists that boys who will require circumcision because of phimosis, balanitis, etc., should not be subjected to the operation at the age when psychological trauma can result. Convention and conformity demand the continuation of the procedure in many areas. The decision to circumcise remains a matter of individual preference as prescribed in the doctor-patient relationship.

Balanitis↗
PubMed2006

[Analysis of shape and retractability of the prepuce in 1,015 Chinese boys aged from 0 to 18 years old].

OBJECTIVE: To evaluate the characteristics of the preputial development in Chinese boys and indications as well as occasion of circumcision. METHODS: The shape and retractability of prepuce were evaluated in 1,015 Chinese boys from 0 to 18 years old without heteroplasia of prepuce and penis. RESULTS: Ratio of children with phimosis decreases progressively with increasing age, from 64.09% in the first group (0 approximately 3 years old) to 7.66% in the fourth group (11 approximately 18 years old). CONCLUSION: Phimosis and incomplete separation of the prepuce is normal in the neonate and infant. Prepuce will separate from the glans progressively till adolescence, so it's unnecessary to perform circumcision for them when without any complications.

Adolescent↗
PubMed1991

[Examination of the prepuce in 511 nursery school children. The role of retraction technics].

The foreskin of 511 nursery school children was examined. Among the 500 unoperated children, 69.4% had a freely retractable foreskin. Adhesions were found in 28% of children and phimosis in 2.6% (total proportion of children with phimosis including the operated cases was 4.5%). A negative history for forcible retraction was found in 63.6% of children; among these subjects, 64% had a freely retractile foreskin and 31.1% had adhesions, which were usually extensive. Among children who had undergone forcible retraction, 77.5% had a freely retractile foreskin and 22% had adhesions, which were minor in most instances (p less than 0.001). The person who performed forcible retraction (the family physician in 54% of cases) and the age of the child at the time of forcible retraction were recorded. This retrospective study in a pediatric population of mean age 3 years 7 months provides data on the outcome after forcible retraction. Mean age at forcible retraction was 13 months in 36.4% of patients. Among the 500 unoperated children, 204 (40.8%) were spontaneously free of foreskin adhesions.

Age Factors↗
PubMed1977

[Carcinoma of the penis: symptomatics, therapy and prognosis (author's transl)].

During the period from 1912 through 1970, 150 cases with a carcinoma of the penis have been examined and treated in the clinics of the university of Göttingen. The preferred age of incidence was between fifty to sixty years. Primary phimosis could be verified in 17.3%, a secondary phimosis, caused by the tumor, in 5.3%. Eighty patients were graded stage I, seventy stage II and more advanced stages. Metastases to the inguinal region were observed in 60.6% out of 99 patients who had undergone lymphadenectomy. Distinctly enlarged inguinal lymph nodes proved to be metastases in only a third of the cases. The staging of a case with carcinoma of the penis, therefore, is not possible by means of clinical criteria alone but needs also a biopsy from the inguinal region. The 3-year, 5-year, and 10-year survival rates amounted to 52.5%, 46.7% and 32.4% and did not depend on treatment techniques. The most promising survival rate resulted from a combination of surgical treatment with high-voltage therapy.

Adult↗
PubMed1997

[Epidemiological study of external genital diseases in 5172 adolescents].

OBJECTIVE: To study the incidence of external genital diseases and the health status of external genitalia in male adolescents in china. METHODS: 5172 male adolescents aged 7-22 were sampled randomly to examine the diseases and health status of external genitalia. According to the diagnostic criteria in textbook Surgery (3rd edition), all examinations were carried out by urologists. RESULTS: The total incidence of redundant prepuce was 67.79%, phimosis 10.09%, varicocele 19.82%, hydrocele 0.87%, concealed penis 0.68%, cryptorchidism 0.39%. CONCLUSION: The health status of external genitalia in male adolescents is bad. Redundant prepuce and phimosis are common diseases. The examination of external genitalia should be carried out in the physical examination of admission. This study may provide the theoretical evidence for prevention and treatment of male external genital disease as well as the important data for study on andrology.

Adolescent↗
PubMed2004

Kindler syndrome in native Americans from Panama: report of 26 cases.

OBJECTIVE: To investigate the clinical, genetic, and laboratory features of 26 patients with Kindler syndrome. DESIGN: Case series of patients recruited when they were seen at outpatient consultations in the Department of Dermatology at the Changuinola Hospital in Bocas del Toro, Panama, between May 1986 and December 1990. SETTING: Clinical history, physical examination, and laboratory studies were done at a community hospital in Panama. Twelve of the patients had further studies performed at a children's hospital in Costa Rica. PATIENTS: A total of 26 patients were entered into the study. They were members of the Ngöbe-Buglé tribe and resided in isolated villages in rural Panama. RESULTS: The major findings were skin fragility with blistering (100%), poikiloderma (96%), photosensitivity (92%), severe cutaneous atrophy (89%), hyperkeratosis of the palms and soles (81%), congenital acral blisters (81%), severe periodontal disease (81%), and phimosis (80% of male subjects). In 1 large family with 10 patients, inheritance of Kindler syndrome followed that of an autosomal recessive disease. Karyotypes in 3 patients and 1 unaffected father were normal. Findings from ultrastructural studies showed replication of lamina densa in 10 patients. CONCLUSIONS: To our knowledge, this study represents the largest series to date of patients with Kindler syndrome. The clinical features confirm previously reported cases, and segregation analysis confirms its autosomal recessive inheritance. We also report severe phimosis as a complication, which has not been previously described in this syndrome.

Adolescent↗
PubMed1989

Human papillomavirus (HPV)-associated male and female genital carcinomas in a Hindu population. The male as vector and victim.

Epidemiologic, histologic and immunohistochemical data concerning male (penile) and female (cervical and vulvar/vaginal) genital carcinomas in a Hindu population are reported. The data are from Bali, an Indonesian Hindu island in a country with a predominantly Muslim population. In contrast to the surrounding Muslim population, circumcision is rare in the people of Bali, and the rate of phimosis in grown men is very high. The Balinese epidemiologic data of 1985 to 1986 were compared with 1986 data from The Netherlands. In Bali, cervical carcinoma was the most frequent carcinoma in women, and vulvar/vaginal carcinoma ranked seven. These carcinomas were much less frequent in The Netherlands. In Balinese men, penile carcinoma is the second most frequent carcinoma, whereas it is rarely diagnosed in The Netherlands. Penile carcinomas are found in Bali in younger age groups than in The Netherlands. Based on the immunohistochemical staining results, it is estimated that over 75% of the studied Balinese genital carcinomas contain human papillomavirus (HPV). The data presented in this paper may indicate that the cofactor of impeded postcoital hygiene can be of great importance for male and female HPV-associated genital carcinogenesis. It is clear that Balinese men, in particular men with extreme phimosis, are both vectors and victims of HPV. In The Netherlands the man is exclusively the vector of HPV.

Adult↗
PubMed1999

Penile lichen sclerosus et atrophicus treated with clobetasol dipropionate 0.05% cream: a retrospective clinical and histopathological study.

BACKGROUND: Treatment with clobetasol propionate 0.05% cream is effective against lichen sclerosus et atrophicus (LSA) of the vulva. OBJECTIVE: The purpose of this study was to retrospectively evaluate whether clinical and histologic responses to topical clobetasol can be accomplished in penile LSA. METHODS: A self-assessment questionnaire was obtained from 22 men with LSA, and a clinical examination was performed in 21 of them. Biopsy specimens from 15 cases were compared before and after treatment. RESULTS: Itching, burning, pain, dyspareunia, phimosis, and dysuria decreased significantly (P < .001 to .05) after 1 to 2 daily applications, for a mean of 7.1 weeks (2-16 weeks). Additional operation for phimosis was required in 6 of the 22 men. All histologic LSA criteria were significantly (P < .01 to .05) reduced after treatment. CONCLUSION: Topical treatment of penile LSA with clobetasol propionate represents a safe and effective therapy with no risk of epidermal atrophy but with some potential for triggering latent infections, most importantly human papillomavirus.

Administration, Topical↗
PubMed1997

Variability in penile appearance and penile findings: a prospective study.

OBJECTIVE: To document prospectively variation in penile morphology and clinical findings in children. PATIENTS AND METHODS: The study comprised a consecutive sample of 468 boys whose consultation with a physician included a genital examination in a primary-care paediatric practice in rural northern Wisconsin. RESULTS: Circumcised boys under 3 years of age were significantly more likely to have a partially or completely covered glans, a reddened meatus, balanitis, or trapped epithelial debris, and less likely to have a fully exposed glans than were circumcised boys of 3 years or older. Among the 238 boys under 3 years, those circumcised were significantly more likely to have non-cosmetic problems, including coronal adhesions, trapped epithelial debris, a reddened meatus, preputial stenosis (phimosis) and balanitis, than were boys with a foreskin. Findings in the circumcised group under 3 years included: fully exposed glans (n = 78, 35.6%), partially covered glans (n = 67, 30.6%), adhesions (25.6%), completely covered glans (20.1%), entrapped desquamated epithelial debris (24.7%), reddened meatus (19.1%), balanitis (15.5%), and preputial stenosis (0.9%). Only two genital examinations in boys with foreskins revealed pertinent findings. Coronal adhesions develop in circumcised boys at 2-6 months of age and usually resolve by 24 months. The degree of skin covering the glans after neonatal circumcision peaks at 6 months of age. CONCLUSIONS: There are significant variations of appearance in circumcised boys; clinical findings are much more common in these boys than previously reported in retrospective studies. The circumcised penis requires more care than the intact penis during the first 3 years of life. Parents should be instructed to retract and clean any skin covering the glans in circumcised boys, to prevent adhesions forming and debris from accumulating. Penile inflammation (balanitis) may be more common in circumcised boys; preputial stenosis (phimosis) affects circumcised and intact boys with equal frequency. The revision of circumcision for purely cosmetic reasons should be discouraged on both medical and ethical grounds.

Adolescent↗
PubMed2002

Common skin disorders of the penis.

Diseases of the male genitalia range from infectious lesions to inflammatory and neoplastic conditions, including many genital manifestations of more general skin diseases. This review highlights the clinical features, diagnosis and treatment of the most common dermatoses of the male genitalia. Herpes genitalis and infections caused by human papillomavirus (HPV) are increasing, particularly in young sexually active people. Herpes simplex virus infection is the commonest infectious cause of genital ulceration, with evidence that many infections are asymptomatic. HPV infection may be latent, subclinical and clinical. The most common causal agents for condyloma acuminatum are low-risk HPV 6 and 11; high-risk HPV types 16 and 18 are associated with premalignant and malignant lesions. Treatment for genital warts remains unsatisfactory; recurrences are common. Imiquimod, a new topical immunotherapeutic agent, which induces interferon and other cytokines, has the potential to be a first-line therapy for genital warts. Scabies and pediculosis are transmitted by skin-to-skin contact and sexual transmission is common, with the penis and scrotum favourite locations for scabious lesions. Oral ivermectin, a highly active antiparasitic drug, is likely to be the treatment of choice, but until approval is granted it should be reserved for special forms of scabies. Common skin diseases, e.g. psoriasis and lichen planus, may have an atypical appearance in the genital area. The typical psoriatic scale is usually not apparent because of moisture and maceration. Allergic contact dermatitis of the genital area may result from condoms, lubricants, feminine hygiene deodorant spray and spermicides. More often, contact dermatitis is irritant, resulting from persistent moisture and maceration. Lichen sclerosus is a chronic inflammatory disease that occurs as atrophic white patches on the glans penis and foreskin. The penile form is a common cause of phimosis in uncircumcised men; involvement of the urethral meatus may lead to progressive meatal stenosis. Plasma cell balanitis is a benign, idiopathic condition presenting as a solitary, smooth, shiny, red-orange plaque of the glans and prepuce of a middle-aged to older man. Squamous cell carcinoma (SCC) in situ, e.g. erythroplasia of Queyrat and Bowen's disease, cannot be excluded clinically; their apparent clinical benignity may lead to lengthy periods of misdiagnosis and biopsy is required to confirm the diagnosis. SCC is the most common malignancy of the penis and the role of oncogenic HPV-types has been also established in SCC of the penis. Prevention of SCC of the penis presupposes an identification of risk factors, early detection of all pre-cancerous lesions and treatment of phimosis.

Balanitis↗
PubMed2003

Glanular reconstruction and preputioplasty repair for distal hypospadias: a unique day-case method to avoid urethral stenting and preserve the prepuce.

OBJECTIVE: To report the early outcome of >200 boys who underwent a glanular reconstruction and preputioplasty (GRAP) repair for distal hypospadias, to assess the functional and anatomical outcome of the penis at least 10 years after surgery, and to compare these data with otherwise "normal" aged-matched controls. PATIENTS AND METHODS: The GRAP repair is a novel method for the day-case reconstruction of distal hypospadias, and uniquely allows the anatomical reconstruction of the prepuce as part of penile reconstruction for hypospadias. We retrospectively reviewed the notes of 205 consecutive cases of distal hypospadias who had a GRAP repair carried out by one surgeon. Of these, there were 63 consecutive patients who had been repaired using the GRAP > or = 10 years earlier. In these patients a questionnaire was used to assess their perception of the appearance of their penis, the urinary stream, any problems with the foreskin and their recollection of surgery. Similar questionnaire data, except for the latter, were obtained from aged-matched controls for comparison. RESULTS: Of the 205 patients, 183 (89%) were day cases; the remaining 22 remained in hospital overnight for medical or social reasons. Sixteen (7%) developed a urethral fistula, the incidence of which correlated positively with the length of the repair. Four children (2%) were circumcised, in two for phimosis resulting in a spraying stream, in a third for dribbling after voiding, and the fourth for a cosmetically unsatisfactory foreskin. Questionnaire responses were received from 45 boys (71%), while 18 were untraceable. The mean (sd) age at surgery and at survey was 3.25 (2.6) and 14.26 (2.8) years, respectively. Forty-two (95%) children felt their penis was normal or only slightly different in appearance, two (5%) felt it looked fairly different and only one mostly avoided communal situations because of this. On voiding three boys (7%) sprayed most of the time while the remainder either never or sometimes sprayed. One youth sometimes had to sit to void because of difficulties in directing the stream; the rest (98%) always stood to void. There were no further circumcisions. These results were not significantly different from those of the age-matched controls. Most children had no (68%) or only slight (30%) recollection of hypospadias surgery. CONCLUSION: The complication rate and patient satisfaction with GRAP is comparable with those of other techniques. GRAP is a simple day-case procedure with few complications, thus avoiding an overnight hospital admission for most patients. Importantly, the prepuce can be preserved and refashioned to give a good cosmetic result, with no phimosis, which is increasingly important as circumcision becomes less acceptable to both the general public and the medical profession.

Ambulatory Surgical Procedures↗
PubMed1997

Surgical treatment of buried penis.

The buried penis is a rare congenital entity, whose treatment is surgical. There are few publications concerning this matter. The authors report on their experience in 10 cases (1990-1995). In this abnormality, the tip of the glans does not project from the pubic or scrotal skin. It is due to: 1) an excessive development of the penile fascia which retracts the penis; 2) insufficient attachment of the penile skin at the base of the penis; 3) often excessive prepubic fat worsens the appearance of the abnormality but does not by itself totally explain it; 4) a tight phimosis is often present. Surgical treatment is necessary because this aspect tends to persist even after puberty. One cannot indeed count on the development at the age of puberty, neither on the diminution of the fat, nor on the simple cure of the phimosis. One must above all ban circumcision which causes the risk of eliminating the skin necessary for reconstruction. The surgical procedure will comprise: 1) a longitudinal dorsal incision extended circumferentially; 2) resection of the thickened fascia penis; 3) anchoring of the deep face of the dermis to the proximal part of the fascia penis at the base of the penis. This surgical procedure has always brought a significant improvement to the appearance of the penis.

Child↗
PubMed2000

Etiology of squamous cell carcinoma of the penis.

OBJECTIVE: To review the epidemiology of invasive cancer of the penis based on scientific publications identified by a Medline search from 1966-2000 for the keywords penis/penile, cancer/carcinoma and risk as well as the cited references in the identified papers. RESULTS: Strong risk factors (OR >10) identified by case-control studies included phimosis, chronic inflammatory conditions such as balanopostitis and lichen sclerosus et atrophicus and treatment with psoralen and ultraviolet A photochemotheraphy (PUVA). A consistent association was found between penile cancer and smoking that was dose-dependent and not explained by investigated confounding factors such as sexual history. Sexual history and self-reported history of condyloma were associated with a 3-5-fold increased penile cancer risk. Cervical cancer in the wife was not consistently associated with cancer of the penis in the husband. Circumcision was associated with penile cancer risk in ecological studies. In a case-control study, circumcision neonatally, but not after the neonatal period, was associated with a 3-fold decreased risk, albeit 20% of penile cancer patients had been circumcised neonatally. In a large number of case series, human papillomavirus (HPV) DNA was identified in penile neoplastic tissue. In penile intraepithelial neoplasia, between 70 and 100% of lesions were HPV DNA positive, whereas invasive penile cancer was positive in only 40-50% of cases. A few serological case-control studies and one prospective study also identified an association between HPV type 16 and penile cancer risk. An association between penile cancer risk and HPV prevalence in the population was also suggested by ecological studies. CONCLUSION: The evidence on risk factors for penile cancer suggests that preventive measures that could be considered include prevention of phimosis, treatment of chronic inflammatory conditions, limiting PUVA treatment, smoking cessation and prophylactic prevention of HPV infection.

Carcinoma in Situ↗
PubMed2004

Results of a simplified technique for buried penis repair.

PURPOSE: The buried penis can cause secondary phimosis, recurrent balanitis and social embarrassment. We report our results using a simplified technique for repair. MATERIALS AND METHODS: A retrospective chart review of 83 consecutive patients undergoing buried penis repair between March 1995 and March 2001 was performed. Indications for surgery included recurrent balanitis, secondary phimosis, difficulty holding the penis during voiding, spraying of the urinary stream, or parental or patient concern for social embarrassment. The technique involves fixation of the subcutaneous penile skin at the base of the degloved penis to Buck's fascia of the penile shaft at the 3 and 9 o'clock positions. RESULTS: For the 79 patients included in the study average followup was 4.4 years. Group 1 consisted of 26 patients who underwent circumcision at the time of buried penis repair. Six patients had hypospadias and 13 had penoscrotal webbing that was repaired simultaneously. Three patients (11.5%) had recurrent buried penis that required a repeat procedure and 1 (3.8%) required revision of the circumcision only. Three patients (11.5%) with penoscrotal webbing had mild recurrence requiring no further treatment. Group 2 consisted of 49 patients who underwent revision of the circumcision at the time of buried penis repair. Seven patients (14.3%) had mild recurrence that did not require further treatment. Group 3 consisted of 4 patients who underwent liposuction at the time of buried penis repair. One patient experienced lymphedema of the ventral distal shaft skin, which required subsequent excision. CONCLUSIONS: The buried penis repair is a simple and effective outpatient procedure with few complications and recurrences. It can be used as a primary or secondary procedure and affords good cosmetic results.

Adolescent↗
PubMed2005

Split-thickness skin graft for the management of concealed penis.

PURPOSE: We review the use of split-thickness skin grafting in children with concealed penis. MATERIALS AND METHODS: Medical records were retrospectively reviewed for all patients younger than 20 years seen at our institution from 1995 to 2003 with a diagnosis of concealed penis. Patients were separated into "primary" and "secondary" groups based on the cause of concealment. Primary factors were prominent prepubic fat pad, dysgenetic dartos fascia or both. Secondary factors were post-circumcision phimosis and overzealous circumcision. RESULTS: A total of 26 patients 1 month to 19 years old were treated. In the primary group of 23 patients 11 underwent lysis of dartos fascia. Four of these 11 patients had insufficient skin, and split-thickness skin grafting was necessary to resurface the penile shaft. Five of the patients underwent excision of the fat pad only, and 2 underwent excision of the fat pad and lysis of fascia. Five patients are being observed. Of the 3 patients in the secondary group 1 underwent manual reduction of post-circumcision phimosis, 1 underwent scrotal flaps and 1 is being observed. Followup ranged from 2 weeks to 46 months (mean 13 months). Of 20 surgically repaired patients 19 (95%) had an excellent cosmetic result, were satisfied with penile length and reported no voiding complaints. CONCLUSIONS: The surgical approach for correcting concealed penis varies, depending on the cause. Of our 26 patients 4 (15%) had insufficient penile skin to resurface the penile shaft. In these select children split-thickness skin grafting provided a good cosmetic appearance and functional result.

Adolescent↗