La Vega slit procedure for the treatment of phimosis

Phimosis in children

Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery.

Triple incision to treat phimosis in children: an alternative to circumcision?

OBJECTIVE

To evaluate the functional and cosmetic results and patient satisfaction after triple incision plasty for phimosis in children.

PATIENTS AND METHODS

The study included 197 boys who had a triple incision for phimosis (mean age 5.8 years, range 0.25-18). The indications for preputial surgery were recurrent balanoposthitis, ballooning during micturition and severe phimotic stenosis. The results after surgery were assessed using a questionnaire about the child's/parent's satisfaction, and an outpatient follow-up examination for functional and cosmetic preputial appearance.

RESULTS

Of 128 parents/children responding, 108 (84%) were satisfied with the function and 102 (80%) reported a good cosmetic outcome. Triple incision as preputioplasty would be recommended to other parents by 119 (93%) respondents. Ninety-one (71%) of the parents feared disadvantages in their son's later life if the child had been circumcised. The outpatient examination showed an excellent functional and cosmetic outcome in 71 (77%) of the children.

CONCLUSION

Triple incision is a simple, fast and safe technique for preputial relief, with good functional and cosmetic results, and was well accepted by the patients.

Surgery to the external genitalia

Surgery to the external genitalia is one of the most challenging chapters of reconstructive urology, due to the need to correct complex problems such as hypospadias or epispadias (isolated or associated to exstrophies). Although this specialty has shown a continuous technical advancement there is no consensus as to the most efficient surgical procedure or to the best strategy to treat these pathologies. The papers reviewed here reflect these statements and reinforce the idea that surgeons' good sense, allied with their experience in the area, are the factors that define the choice of the ideal surgical option for each case.

Neonatal circumcision. Benefits, risks, and Family teaching

Neonatal circumcision is a frequently performed elective surgical procedure, and is one of the oldest known surgical procedures. Neonatal circumcision may be performed for medical, cultural, or religious reasons. This article provides current information from the literature regarding the risks, benefits, and concerns about neonatal circumcision.