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We report the 2nd case of titanium balanitis reported in the world literature. Clinically the patient presented with phimosis: histologically the titanium was surrounded by a mixed granulomatous inflammatory reaction. Topical titanium preparations may lead to phimosis and therefore we thought it important to bring this potential iatrogenic complication to further notice.
All 117 boys circumcized for phimosis during one year at the Department of Pediatric Surgery in Lund were subject to a follow-up study five years postoperatively. In 45 cases the main operative indication was recurrent balanitis, in 25 cases scarring of the prepuce and in 41 cases an expressed ballooning at voiding. Early operative complications included 7 cases of postoperative haemorrhage which in 1 case necessitated reoperation. In 1 case there was a postoperative infection. 13/117 patients developed a stricture of the urethral orifice necessitating meatotomy. The study included a questionnaire which was answered by 97/117 patients, 92 of whom expressed complete satisfaction with the operation. The complaints of the others were cosmetic in nature. There was in no instance any sign of more severe psychological disorder than a certain shyness which was expressed in 8 cases. It is concluded that circumcision for phimosis in young boys is complicated by meatal stenosis in a certain frequency (13/117) but not loaded with serious complications. There seems to be no reason to fear psychological disturbances due to circumcision.
The aim of this study was to evaluate the efficacy of steroid application in the treatment of childhood phimosis. In a consecutive study 91 boys were treated with application of topical betamethason 0.05% cream twice daily. The foreskin was treated for one month, with an attempt at foreskin retraction after fourteen days. Treatment was controlled after one month and six months. Sixty boys achieved full retraction of the foreskin and nine had partial retraction and relief of symptoms. Twenty-two boys had unsatisfactory response and had an operation. Forty-five boys were controlled after six months, 13 had recurrence, of these nine were satisfied and free of symptoms, two had a new steroid treatment with full success, and two wanted a circumcision. A total of 74% did not need an operation after topical steroid treatment. No side-effects or complications were registered. Childhood phimosis can be successfully treated with steroid application, and the treatment should be offered prior to an operation.
Phimosis, i.e. congenital or acquired preputial stenosis, is one of the most frequent problems encountered in surgery departments. Circumcision remains the most frequently adopted surgical treatment, but, since this operation entails the sacrifice of the prepuce and frenulum, the penis loses its natural protection. The Authors describe five years of experience with postectomy, a technique which spares both the prepuce and frenulum while repairing the preputial phimosis, defining its benefits compared with circumcision.
Many of the boys diagnosed with 'phimosis', who are referred for circumcision, do not have a dermatopathology and thus there is no indication for surgery. If an unretractable prepuce causes hygienic problems, and also in the case of dermatopathology, topical corticosteroid application may be an effective alternative to circumcision. In a literature search 13 studies were found on the effectiveness and the safety of topical steroid application for phimosis. Three of the studies were placebo controlled. A total of 1121 boys with an unretractable prepuce were treated with a topical corticosteroid, which was mostly applied twice daily. After a treatment duration of 4 to 8 weeks, about 75% of the patients achieved complete retractability of the prepuce. In the studies evaluated, local or systemic adverse effects were not noted. Different types of corticosteroids gave similar results. Topical corticosteroid application for the treatment of unretractable prepuce complaints seems to be effective and safe, and is therefore recommended before surgical intervention is considered.
A 16 year old boy presented with accelerated hypertension and urinary tract obstruction caused by phimosis. Relief of the obstruction by circumcision reversed the hypertension. We believe that accelerated hypertension secondary to phimosis has not previously been described.
We evaluated the early efficacy of non-surgical treatment using 0.07% betamethasone valerate ointment on, 34 boys with phimosis between January 2001 and June 2005. Patients were treated with 0.07% betamethasone valerate ointment applied to the distal aspect of the prepuce every other day for 2-6 weeks. During the treatment period, patients were instructed to retract the foreskin to penis root without overstraining. The overall success rate was 94.1% and therapeutic effects were observed in 58.8% of the patients in two weeks. There were no medical side effects. Treatment using betamethasone valerate ointment is very effective, easy and safe. We recommend this treatment for patients with phimosis and/or those with recurring balanoposthitis.
A 12-year-old boy presented with nocturnal enuresis. He could not void in a stream and urine dropped out of the external urethral orifice. Physical examination revealed the stenosis of prepuce and balanoposthitis. An intravenous pyelogram and a cystogram showed bilateral hydroureteronephrosis and bilateral vesicoureteral reflux. He was diagnosed with severe true phimosis complicated with bilateral hydroureteronephrosis and bilateral vesicoureteral reflux. His balanopothitis was treated with antibiotics for a few days. Dorsal slit of prepuce and release of adhesion between glans and prepuce were subsequently performed. Four months after operation, an intravenous pyelogram revealed regression of hydronephrosis. Bilateral vesicoureteral reflux was not observed on the cystogram. The possibility of upper urinary tract involvement must be considered in patients with true phimosis and dysuria.
Worldwide in about ten percent of boys general circumcision is performed. The motivations are religious or other rites and ethnic customs, but no scientific medical indication exist for this intervention, even not the small group with inborn phimosis. For these until now only the surgical way is given by circumcision. In 56 cases of boys before puberty with severe phimosis 53 could be completely cured by combined parenteral HCG and local Corticoid treatment within 4-6 weeks. The longtime follow up study did not show any later side effect. The therapeutic scheme is given.
Inborn or acquired stenosis of the prepuce is usually relieved by surgery. From the beginning of the nineties work was published where for treatment a steroid cream applied locally is used. The authors describe the method and achieved results of local non-surgical treatment using a corticoid cream made in the Czech Republic. The authors treated phimosis in a total of 44 boys. In 26 the phimosis was congenital, in 18 it was acquired. In the group of inborn phimoses cure was achieved in 100% and in the group of acquired affections in 72%. The final effect of treatment is according to the authors experience influenced by the interest and co-operation of the parents.
Fifty-three boys were interviewed 11 years (9-14 years) after an operation for phimosis using the Plastibell technique. The interview concentrated on the cosmetic result, sexual function and late complications. Seventeen patients (31%) experienced cosmetic complications, and 11 patients (21%) claimed to have experienced psycho-social problems due to the appearance of the penis after the operation. Nonetheless an overall of 44 patients (83%) were fully satisfied/satisfied with the cosmetic result. Four patients (8%) claimed to have pain or discomfort on erection or intercourse. One patient (2%) was re-operated three years after the primary operation because of a recurrence of the symptoms. Overall 48 patients (91%) were fully satisfied or satisfied with the result after the operation. In conclusion we find the Plastibell procedure to be a safe and reliable method in treating phimosis. There are some minor technical pitfalls that have to be addressed in learning the technique, but performed in trained hands, the technique offers a very high satisfaction rate at long term follow-up.
BACKGROUND: To device a new surgical technique of preputial plasty for the treatment of phimosis, as an alternative to circumcision, easy to perform, which preserves the normal function of the prepuce. METHODS: The new technique consists of three lengthwise incisions of the stenosing wase and their diagonal suture, the triple incision preputial plasty, described by others, modified adding frenulotomy and two more incisions between the previous ones, which are left to heal spontaneously. This technique has been applied on 22 children over a period of 24 months, with a follow-up of six-twenty-four months. RESULTS: The technique is easy to perform. All check-ups show good cosmetic results, no recurrence, normal preputial anatomy and function. It is important to continue "preputial gymnastics" until stabilization. CONCLUSIONS: The devised technique fully succeeds in preserving a normal prepuce, it is easier to perform and safer than other preputial plasties and it may be carried out in all cases of phimosis in pediatrics. The good results achieved encourage us to continue along this path, hoping that the technique will be largely applied.
Three cases of severe capsular phimosis following augmented phacotrabeculectomy complicated by intense postoperative fibrinous uveitis are described. The marked inflammation was possibly related to the combined procedure itself, the excessive intraoperative manipulation to stretch the pupil, and the compromised blood-aqueous barrier after prolonged use of pilocarpine. The combination of fibrinous uveitis and the small size of capsulorhexis attained through a stretched pupil are possible risk factors for developing severe capsular phimosis in the absence of zonular weakness or preoperative uveitis. For patients with similar risk factors, two separate surgical procedures should be considered. Alternatively, a larger capsulorhexis or radial relieving incisions should be attempted during phacotrabeculectomy to prevent this complication, which could jeopardize the outcome of otherwise successful surgery.
A new surgical solution to correct the rare anomaly of asymmetric phimosis is described, with a note on its symptomatology and etiopathogenesis.
The pathogenesis of the prune belly syndrome (PBS) remains controversial, but two theories predominate. The first theory supports an obstructive phenomenon early in gestation leading to irreversible damage to the genitourinary tract and abdominal wall. The second theory suggests mesodermal injury between the 6th and 10th weeks of gestation as the primary abnormality. This paper reports of two fetuses with the PBS phenotype that were examined postmortem at our institution. Thorough examination of the lower urinary tract allowed demonstration of anatomic obstruction of the urethra in both cases. One case illustrated a relatively common pattern of proximal penile urethral obstruction, a flap-like obstruction between the prostatic and penile urethra. The other case provided what we believe to be the first description of PBS caused by severe phimosis.
The effect of hydrocortisone (HC), the steroid of lowest potency, and physiotherapy (PT) on non-retractile physiologic phimosis (PP) and the reduction of subsequent recurrent UTI was evaluated in male infants with UTI. Seventy-eight male infants with febrile UTI and nonretractile PP were prospectively randomized into HC (Plancol, n=39) and control (Vaseline, n=39) groups. Topical application of HC as a thin film around the preputial margin twice a day for four weeks with PT was instructed. The response rate in the HC group was 89.7% (35/39), which was significantly higher than the rate (20.5%; 8/39) in the control group (P<0.05). In the HC group, the response rate was much higher (96.1%) in the subgroup with PT than in the group without PT. Most of the response (88.5%) was observed within two weeks. During the following year, the recurrent rate of UTI was 7.1% (2/28) in the infants with retractile prepuces, which was significantly less than than the rate (29.6%; 8/27) in infants with nonretractile prepuces (P<0.05). In conclusion, topical HC and PT for 2-4 weeks proved to be a simple, safe and effective treatment for nonretractile PP in infants with UTI, and this procedure was beneficial in reducing recurrent UTI.
Phimosis of the foreskin secondary to radiotherapy for a pelvic malignancy has not been previously described in the world literature. However, as radiotherapy is ever more widely used in the treatment of various pelvic malignancies, it is important to ensure that this complication is prevented by the use of appropriate penile shielding.
The importance of phimosis and lack of penile hygiene to explain the high incidence of carcinoma of the penis found locally is discussed.