Related Experiment Videos
Penile adhesions after neonatal circumcision
L E Ponsky1, J H Ross, N Knipper
1Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Insights
Penile adhesions in circumcised boys decrease with age and often resolve spontaneously. This study suggests non-intervention for most adhesions, except those on the circumcision line.
Area of Science:
- Pediatric Urology
- Dermatology
Background:
- Penile adhesions are a common post-circumcision complication in boys.
- The natural history and optimal management of these adhesions remain debated.
- Spontaneous resolution is a key consideration in clinical decision-making.
Purpose of the Study:
- To investigate the incidence of penile adhesions in circumcised boys based on age.
- To assess the natural history and spontaneous resolution rates of penile adhesions.
- To inform management guidelines for penile adhesions in pediatric patients.
Main Methods:
- A retrospective evaluation of 254 circumcised boys presenting to a pediatric urology clinic.
- Classification of adhesions using a 4-grade system (0-3) based on severity and extent.
- Data collection included patient age, adhesion grade, previous treatments, and presence of skin bridges.
Main Results:
- Adhesion rates decreased significantly with age: 71% in boys <12 months, 28% in 13-60 months, 8% in 61-108 months, and 2% in older boys.
- Severe adhesions (grade >1) were most common in infants (<12 months) and rare in older children.
- Only 7 patients had prior treatment, with 3 experiencing recurrence; skin bridges were noted in 6 cases.
Conclusions:
- Penile adhesions are age-dependent, with a high incidence in infants that declines with age.
- Findings suggest that penile adhesions commonly resolve spontaneously without intervention.
- Non-operative management is recommended, except possibly for adhesions involving the circumcision line.
Purpose:
The appropriate management of penile adhesions in circumcised boys is unclear. An important consideration is whether adhesions resolve spontaneously. We studied the incidence of penile adhesions as a function of patient age to assess the natural history.
Materials And Methods:
We evaluated all circumcised boys presenting to our pediatric urology clinic. A standard form was used to classify adhesions as grade 0-no adhesions, 1-fine adhesions to the corona, 2-adhesions covering less than 50% of the glans and 3-adhesions covering greater than 50% of the glans. All boys were evaluated by 1 of 2 pediatric urologists. Previous treatment of adhesions was assessed and skin bridges were also noted.
Results:
We enrolled in our study 254 boys 1 month to 19 years 8 months old. Only 7 patients had a history of treatment of adhesion, of whom 3 had recurrent adhesions at evaluation. Patients were divided into groups based on age, including younger than 12 months (61), 13 to 60 (78), 61 to 108 (51) and 109 months old or older (64). In these groups we noted an adhesion rate of 71%, 28%, 8% and 2%, respectively. The rate of adhesions more severe than grade 1 was 30%, 10% and 0% in boys 12 months old or younger, 13 to 60 and 61 months old or older, respectively. The oldest patient with grade 3 adhesions was 31 months old. Skin bridges in 6 cases involved the circumcision line in 4.
Conclusions:
Penile adhesions develop after circumcision and the incidence decreases with patient age. Although there is debate on whether to lyse these adhesions manually, our findings suggest that adhesions resolve without treatment. Based on our results we do not recommend lysing penile adhesions, except perhaps those involving the circumcision line.