Pediatric Foreskin

A:  Long foreskin / long prepuce / phimosis often affects the pediatric patients as in the followings:

• Patients with phimosis may have difficulty in passing urine resulting in ballooning of prepuce during urination.
• There is often trapping of urine in between prepuce and glans of penis after urination. This trapped urine may subsequently leak out and wetting the underwear or the pant of the boy, causing poor hygiene and odor.
• Phimosis may lead to inaccurate urine stream or urine stream bifurcation resulting in urine wetting the patients' body, clothing or the surrounding environment.
• Patients with phimosis/ long prepuce usually cannot retract and clean their foreskin and glans of penis.  There is often urine and dirt (smegma) accumulating between the glans of penis and prepuce resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitis or even urinary tract infections. Subsequent to recurrent infection and inflammation, the prepuce, glans of penis, urethral opening, frenulum or penile shaft may develop fibrous tissue and scar, resulting in adhesions between glans of penis and prepuce, worsening phimosis secondary to scarring, frenulum breve with scarring, fibrotic urethral stricture, penile distortion, glans of penis distortion or deforming etc.      

If you have symptoms at the prepuce, delaying treatment may induce other diseases, affect the normal growth and development of penis. 

If you have long foreskin / long prepuce / phimosis troubling you, please find an experienced surgeon for medical advice and consider treatment.

A: The foreskin is not retractable in almost all newborns. At around three years old, about 50% of the foreskin can be retracted and exposed the glans of penis. During puberty (about 12-13 years old), more than 90% of the foreskin can be retracted and exposed the glans of penis. More than 95% of the male adults' foreskin can be retracted and exposed the glans of penis.

If you have long foreskin / long prepuce / phimosis troubling you, please find an experienced surgeon for medical advice and consider treatment.

A: Yes. For patients having long foreskin / long prepuce / phimosis, there is often urine, debris and bacteria trapping between the glans of penis and the foreskin, causing unpleasant odor. Besides, this would increase the chance of bacterial balanitis, posthitis, urinary tract infection etc. You need to clean the prepuce and glans of penis after urination.

A: There are many secretary glands in the prepuce and glans of penis. There is often urine, skin secretions and dirt (smegma) accumulating between the glans of penis and prepuce resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitis or even urinary tract infections. Boys and men should retract the foreskin and clean the foreskin and the glans with water (+/- soap / bath gel) everyday if possible.

A: Circumcision is a minor operation. The risks and complications are of less than few percent.

A: Patients are fully alert during their circumcisions. Experienced surgeons use safe dose of local anesthesia and inject it subcutaneously. When the skin is totally painless, experienced surgeons will perform circumcisions and suturing.

A: You needs about 1 - 2 weeks of sick leave after traditional circumcision. You will can perform exercise 4 weeks afterwards.

If you had new generation laser circumcision, you can return to school the same day or the next after surgery. You can start gentle exercise 2 -3 weeks after surgery. You can start swimming 3 - 4 weeks after surgery.

Please refer to the treatment workflow on the right.

A: For traditional circumcision, patients need to use normal saline, distilled water or antiseptic solution to clean the wound after showering or urination. It may take 2 weeks or above before you can go out casually.

For new generation laser circumcision, wound care is simply keeping the wound dry.

A: If your son is not often following to commands, we can arrange circumcision under general anesthesia in hospital.

A: Patients usually are admitted to the hospital in the morning and have the circumcision in the morning. They are normally discharged from the hospital on the day after circumcision. If the surgeons think the condition is appropriate, some patients may be discharged the same day after circumcision.

Please refer to the treatment workflow on the right.

A: The postoperative pain score (VAS: 0-10) after traditional circumcision is moderate to severe (5 - 8). The postoperative pain score (VAS: 0-10) after the new generation laser circumcision or plastibell circumcision are nearly zero.

A: No. If your son is suffering from phimosis/ long foreskin / long prepuce/ paraphimosis / foreskin diseases (such as warts, sebaceous cysts, recurrent balanitis, recurrent posthitis, recurrent urinary tract infection, seborrheic keratosis, balanitis xerotica obliterans etc), then you need to consider circumcision for your son. Parents bringing their sons for circumcision have to understand the need for the circumcision, the pros and cons of different kinds of circumcision, and to give informed consent before the surgery. Foreskin and glans of penis varies greatly from one person to another. If you have any enquiry, you should bring your son to an experienced doctor for advice.