Varunkumar Maddileti, Suhasini Gazula, Praveena Dantala
MCh, Department of Pediatric Surgery, ESIC medical college Hospital, sanath nagar, Hyderabad.
MCh, Department of Pediatric Surgery, ESIC medical college Hospital, sanath nagar, Hyderabad, Email:
Malays Fam Physician. 2022 Mar 15;17(1):52-56. doi: 10.51866/oa.27. eCollection 2022 Mar 28.
Aside from religious circumcisions, the indications for circumcision are few. However, in the cultural context, many patients are unnecessarily referred for circumcision for physiological phimosis (adhesions). Due to parental concerns and misperceptions by general practitioners, non-retractile prepuce is one of the most common indications for referral to a paediatric surgeon in many countries. This study aimed to determine whether preputial adhesiolysis successfully managed symptomatic non-retractile foreskin and therefore prevented the need for circumcision.
A retrospective review was performed of the health records of children who presented with preputial adhesion. We included 65 symptomatic patients (ballooning of the prepuce in all cases and additional dysuria in three cases) who underwent preputial adhesiolysis. All cases were followed up for 2 years. Circumcision was subsequently carried out for patients who developed fibrous scarring resulting in difficult retraction due to the development of thick adhesions or skin fissuring with persistence of symptoms.
Of the 65 boys, 58 (89.2%) achieved complete retraction of the prepuce. The remaining 7 boys (10.8%) presented with recurring symptoms and thick fibrosed prepuce, and they underwent circumcision due to the dense adhesions. Histopathological examination of the circumcised prepuces revealed balanitis xerotica obliterans in two cases.
Preputial adhesiolysis is a safe and effective treatment for symptomatic preputial adhesions in boys younger than 5 years old. The procedure avoids circumcision and its associated risks. Preputial adhesiolysis should be offered as a primary treatment instead of circumcision.
除宗教割礼外，割礼的适应症很少。然而，在文化背景下，许多因生理性包茎（粘连）而不必要地被转诊去做割礼的患者。由于家长的担忧和全科医生的误解，在许多国家，包皮不能上翻是转诊给小儿外科医生最常见的适应症之一。本研究旨在确定包皮粘连松解术是否能成功治疗有症状的包皮不能上翻，并因此避免割礼的必要性。
对有包皮粘连的儿童健康记录进行回顾性研究。我们纳入了65例有症状的患者（所有病例均有包皮气囊样扩张，3例伴有排尿困难），他们接受了包皮粘连松解术。所有病例均随访2年。对于因粘连增厚导致纤维瘢痕形成而难以回缩或症状持续存在且皮肤裂开的患者，随后进行了割礼。
65名男孩中，58名（89.2%）包皮实现了完全上翻。其余7名男孩（10.8%）症状复发且包皮纤维增生，因粘连致密而接受了割礼。对割下的包皮进行组织病理学检查，发现2例有闭塞性干燥性龟头炎。
包皮粘连松解术是治疗5岁以下男孩有症状包皮粘连的一种安全有效的方法。该手术避免了割礼及其相关风险。应将包皮粘连松解术作为主要治疗方法而非割礼。
