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[Should circumcision be performed in childhood?]
Julio César Morales Concepción1, Emilio Cordiés Jackson, Marlen Guerra Rodríguez
1Hospital Pediátrico de Centro Habana, Hospital Pediátrico del Cerro, Ciudad de La Habana, Cuba.
Insights
Prepuce retractability naturally improves with age, becoming fully retractable in most adolescent boys. Circumcision and forced dilation have limited indications in childhood due to common, normal adhesions.
Area of Science:
- Pediatric Urology
- Developmental Biology
Background:
- Incomplete separation of the prepuce and glans penis is a normal finding in newborns.
- Spontaneous separation typically occurs during childhood and adolescence.
Purpose of the Study:
- To assess prepuce development and retractability in boys aged 0-16 years.
- To evaluate the necessity of circumcision and forced prepuce dilation in childhood.
Main Methods:
- Evaluation of prepuce development and retractability in 400 boys aged 0-16 years.
- Assessment of retractability in younger boys without prior forced dilation.
Main Results:
- In boys under 1 year, 71.5% had non-retractile prepuces (Type I), compared to 5.5% with completely retractile prepuces (Type V).
- In adolescent boys, 82.3% had Type V retractile prepuces, with only 1.6% showing Type I.
- 106 boys who underwent forced dilation previously developed adhesions again; only 2.7% required circumcision for conditions like stenosis or recurrent balanitis.
Conclusions:
- Incomplete prepuce-glans separation is normal in newborns and resolves spontaneously by adolescence in most cases.
- Circumcision and forced prepuce dilation have limited indications in childhood based on study findings.
- Natural development leads to complete separation in the majority of boys by adolescence.
Objective:
To evaluate prepuce development and retractibility in a group of boys. To point out the value of circumcision and prepucial forced dilation during childhood.
Methods:
Prepuce development and retractibility were evaluated in 400 boys ages between 0-16 year old.
Results:
In boys under 1 year prepuce retractibility (assessed only in children who did not undergo forced dilation previously) was type I (non retractile) in 71.5% whereas type V (completely retractile) was only 5.5%. In adolescent boys type I prepuce was observed in 1 boy only, 1.6%, whereas type V was observed in 82.3%. Furthermore, it was observed that at the time of examination for the study 106 boys who had undergone forced dilation at an earlier age had balano-prepucial adhesions again, which demonstrates that prepuce adheres again to glans penis in many boys after a forced dilation is performed. Only 11 boys were considered in need for circumcision, three of them for prepucial orifice stenosis, which prevented normal micturition, causing a prepucial sac, one case due to a constrictive ring below the prepucial edge that would have prevented ulterior retractability, two cases with repetitive balanopostitis, and five cases secondary to xerosol balanitis, accounting for 2.7% of all examined boys.
Conclusions:
Incomplete separation between prepuce and glans penis is normal and common among new-borns, progressing until adolescence to spontaneous separation, at which time it is complete in the majority of boys. Accordingly to the criteria we have sustained for years and present study's findings, circumcision has few indications during childhood, as well as forced prepucial dilation.