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Tuesday, January 27, 2009

Phimosis Scare

Just a few days ago, my 6 yo son was complaining that it hurts when he was urinating. We got a little worried as he had a history of recurring Urinary Tract Infection when he was younger. It was a very bad experience for us as we had to put him through an x-ray test for urinary reflux/vesico-ureteral reflux (VUR). The test is called Micturating Cysto-urethrogram (MCU). It pains us that he has to go through an x-ray test at such a young age, but I guess it's much better than to have VUR and thus taking risk of renal scarring (kidney damage). Anyway, I'll talk about that some other time.

As I was saying, we got worried about him complaining that it was painful while he was urinating, so we decided to check his penis ourselves and found out that there is sort of a cut there. To be sure, we decided to bring him to see our Sunday pediatrician (since our usual pediatrician doesn't work on Sundays), at the very least, get an antiseptic cream to prevent any form of infection. The doctor said that it's just a small cut or a bug bite and gave us an antiseptic cream.

Since our son is seeing a skin specialist (dermatologist), we also let him take a look at my son's penis for a second opinion. He said that there's no infection but he saw that my wife was having some difficulty retracting my son's foreskin and my son was complaining that it hurts when she tried to retract the foreskin. He then said that there may be tightening of foreskin, which may lead to more problems (such as UTI) when he gets older. He recommended us to see a
pediatric surgeon in SDMCSJ (previosly SJMC - Subang Jaya Medical Centre) to do a circumcision. According to him a pediatric surgeon is gentler and more experience operating on children as compared to a pediatrician or a general surgeon. The operation should only take about 10 mins but he would have to stay for half a day in the hospital. We asked if it's something we needed to do it immediately and he said we can do it within the next six months.

It was then I decided to do a search online and found out about Phimosis.

According to Krames Online:-
In uncircumcised boys, the foreskin lies over the head of the penis. It begins to loosen from the head of the penis by age 3. This allows the foreskin to gently retract (slide back) over the head of the penis. In some boys, the tip of the foreskin (prepuce) is very tight, making it difficult to retract. This is phimosis.
The unretracted foreskin and prepuce cover the penis. Retraction of the foreskin uncovers the head of the penis. (Source: Krames Online)

Phimosis is most likely to be identified between 4 yo to 7 yo since for younger children, their foreskin may not be able to fully retract. The last time our son got his penis checked was when he was younger (around 2 or 3 yo), so we decided to let our usual doctor check him again. Thankfully he said that he doesn't have the signs of Phimosis. It probably hurts because he was terrified by last few days experience and furthermore it's a sensitive area. He just need some getting used to the stretching of foreskin and slowly it will be able to retract. There's no rush, according to him. He also does not recommend going for circumcision until he's a little older because if we do it now, he will need to go under General Anesthetic as he's probably too immature to stand still for the administration of a Local Anesthetic.

In any case, we're glad that our son is ok and nothing needs to be done at the moment, thank God!!

To get more information about Phimosis, when to see the doctor, and the treatment for it, please visit Krames Online.



Anonymous said...

how did you managed a MCU if the foreskin is not retracted?

Daddy-O said...

To Anonymous,

Sorry was unable to respond earlier.

From what I remember during the MCU procedure, the dr. basically put small soft plastic tube (catheter) from the urethral opening, through the urethra all the way to the bladder. He then proceed to fill the bladder with liquid (a dye that can be seen on x-ray) until the bladder is full. Usually for very young children who are not toilet train, they will wee when the bladder is full.

They will take the x-ray while the child is urinating.

So long story short, in my opinion, if you can urinate, you can manage a MCU since all it needs is a urethral opening. Will a foreskin that can't be retracted fully makes it trickier to perform a MCU? I can't say for sure, but it was ok for my son. You can always ask your doctor for confirmation :).


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