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Phimosis of infants and young children in Japan
1Department of Pediatrics, International Medical Center of Japan, Tokyo, Japan.
Insights
Phimosis, or foreskin adhesion, is common in infants but often resolves naturally. Surgical correction is generally not needed in early childhood unless urological issues are present.
Area of Science:
- Pediatric Urology
- Neonatal Health
Background:
- Phimosis, the inability to retract the foreskin, is a common condition in infants and young children.
- Understanding the natural progression of phimosis is crucial for appropriate clinical management.
Purpose of the Study:
- To investigate the prevalence and natural resolution of phimosis in healthy Japanese infants and young children.
- To provide data to inform clinical recommendations regarding foreskin management.
Main Methods:
- A cross-sectional study examining the prepuce and glans in 4521 healthy infants and young children (birthweight > 2600g) in Japan.
- Data collected on age, presence of phimosis, and retractability of the foreskin.
- Prevalence rates calculated for different age groups.
Main Results:
- Phimosis was observed in 88.5% of infants aged 1-3 months, decreasing to 35.0% by age 3 years.
- Foreskin retractability through gentle manipulation increased with age, reaching 38.4% in 3-year-olds.
- Complete adhesion was common in infants; a small space was noted in some 3-year-olds. Smegma and balanoposthitis were rare.
Conclusions:
- Phimosis is a normal finding in most infants and typically resolves spontaneously.
- Forcible separation of the foreskin is not recommended due to risks of bleeding and paraphimosis.
- Surgical intervention for phimosis is generally unnecessary in infancy and early childhood, barring associated urological complications.
Abstract:
The prepuce and glans was examined in 4521 healthy infants and young children with a birthweight over 2600 g. There were 3238 infants aged 1-12 months and 1283 children aged 3 years. There is no custom of circumcision in Japan. The term phimosis implies the adhesion of the prepuce and glans, which cannot be separated by manipulation. Phimosis was found in 88.5% of infants aged 1-3 months, and the corresponding figures at the ages of 4-6 months, 7-9 months, 10-12 months and 3 years were: 74.4, 63.9, 58.0 and 35.0%, respectively. However, cases where the prepuce could be retracted by gentle manipulation were found in 3.0% of infants aged 1-3 months, 19.9% of those aged 10-12 months and increased to 38.4% of children aged 3 years, which exceeded the rate of phimosis. The complete adhesion of prepuce and glans was found in many infants, and a small space between the prepuce and glans was observed in some cases of 3-year-old boys. The smegma was notable in only 16 cases (0.5%) of infants and in 5 cases (0.4%) of the 3-year-olds. Balanopothitis was found in only one case of the 3-year-olds. It is not recommended to separate the foreskin by manipulation, which sometimes leads to bleeding or paraphimosis. And it is not necessary to surgically correct phimosis in infancy and early childhood except in the case of accompanying urological disturbance.