I am a nurse practitioner and have been aware of the controversy of opeinng penile adhesions that occure after a circumcision in the office for a long time. I recently saw a child who had had this done a few days before and had a very irritated penis and the foreskin had reattached itself. What is the current feeling among pediatric urologists about this subject ? I usually tell parents the foreskin will take care of itself. am I incorrect ? Thanks
Uncircumcised penises usually "take care of themselves" and do not need the foreskin retracted until puberty. At puberty and beyond, on a daily basis the foreskin needs to be retracted and washed and then pulled back down.
Following circumcision, reattachment of the foreskin to the head of the penis can occur. This can be either the recurrence of what I call "physiologic" adhesions ( the type that exists beneath the uncircumcised pediatric foreskin) or "dense" (again, the term is mine) adhesions that result in permanent skin bridging. These latter ones are true scars and will not resolve at puberty as do the physiologic ones. They can both be prevented by gently making sure that the penile skin does not remain in contact with the head of the penis during the healing that follows circumcision. Gently pulling the skin down from covering the head of the penis and applying a vaseline based antibiotic ointment (such as bacitracin) with each diaper change until complete healing (10 days or so) has occurred should be adequate. Forcefully, repeated, disruption of these adhesions is not good and will result in dense adhesions, scarring and possibly infections.
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