During the summer break, many young boys undergo a special rite of passage—the circumcision surgery. At this time each year, hospitals are bustling with patients. Parents, amidst the wave of circumcision procedures, are left questioning: Is circumcision necessary?
Dr. Wang Dejuan, the head of our pediatric surgery department and deputy head of urology, reminds parents that circumcision is not a decision to be made lightly; it should be based on the child’s specific circumstances. Parents should avoid blindly following trends and ensure their child’s health and safety.
What is phimosis/long foreskin?
Long foreskin refers to a condition where the foreskin covers the urethral opening but can be retracted to expose the urethral opening and the glans.
The incidence of phimosis in newborns exceeds 90%, and most boys resolve this condition after age 3. Phimosis means that the glans is covered by the foreskin, which cannot be retracted to reveal the glans and the urethral opening. The foreskin can accumulate smegma, creating a breeding ground for infections, and long-term phimosis in adults may lead to cancer.
When is circumcision necessary?
1. Long foreskin causes difficulty in cleanliness, leading to inflammation and recurrent urinary tract infections; the child often has unsatisfactory urination.
2. Phimosis, meaning the opening of the foreskin is too narrow to expose the glans, affects normal daily life and hygiene. Would lead to frequent itching, and the child may frequently pull at the foreskin.
3. If the foreskin cannot be retracted after age 3.
4. An obviously long foreskin that extends beyond one-third of the glans.
5. Scarred foreskin (pathological phimosis).
It is important to differentiate this from concealed penis syndrome; not every child with phimosis requires circumcision.
Concealed penis syndrome, also known as buried penis or hidden penis, refers to a condition in which a normally developed penis is hidden beneath the pubic fat pad, resulting in an appearance that seems to be a short penis. The incidence is 0.68%, just after long foreskin and phimosis.
How to care for the patient post-surgery and promote quick recovery?
After circumcision surgery, the glans should be covered with gauze or elastic bandage to apply pressure on the wound to stop bleeding and reduce swelling; the dressing is usually removed after 2 to 3 days. Before removing the dressing, caregivers should closely monitor the wound for any signs of bleeding or ischemia.
During the dressing period, the child may experience the following conditions, which require careful observation and possible medical attention:
Difficulty urinating
This can be caused by the child’s pain causing them to resist urination (the child must urinate at least once before leaving the hospital), or due to an erection causing the dressing to compress the urethra, resulting in noticeable pain and an erect appearance; return to the hospital to ease the dressing and manage pain further.
Dressing contamination with urine
Urine soiling the dressing will not lead to wound infection in a short time, so immediate return to the hospital isn’t necessary; the child can be seen at the specialty outpatient clinic the next day or wait for dressing removal.
Loose dressing
If the dressing becomes loose without noticeable bleeding, there’s no need to return to the hospital for re-dressing; cleaning the wound with a gentle solution can begin (if loosening occurs during hospitalization, report immediately to daytime nurses and contact the surgeon for a wound examination).
Wound discharge
During the dressing period, there may be a small amount of light yellow discharge around the gauze, on the glans, or at the urethral opening, even forming crusts. This is a normal part of the recovery process; maintaining local disinfection and dryness is crucial. If the discharge causes urinary issues, immediate attention should be sought.
