Editing CUA: Circumcision (2018) (section)

== Answers ==

# What are the mechanisms that result in physiological retraction of the foreskin? By what age is this process usually complete by? At what age should intervention be considered if the foreskin is not reduced naturally? What intervention should be considered at this age?
#* Repeated erections and accumulation of smegma
#* Age 3
#* Age 8-10
#* Topical steroids
# Parents of a child ask if they should retract the child’s foreskin during bathing for genital hygiene? When should foreskin care be initiated?
#* They should not as it increases risk of scar formation
#* Foreskin care should be initiated when foreskin is reducible
# What are indications for urological referral in a patient with phimosis?
## Recurrent balanitis
## Recurrent UTI, possibly in context of associated abnormality (high-grade VUR, PUV, primary megaureters)
## Phimosis associated with lichen sclerosis
## True pathological scarring
# Which steroids are recommended to treat persistent phimosis?
#* Moderate potency such as hydrocortisone
# Which children are most likely to benefit from circumcision to reduce the risk of UTI?
#* Boys with urologic abnormalities (high-grade VUR, PUV, primary megaureters)
# In which patient population has circumcision been shown to the risk of HIV transmission?
#* Females to males
# What is the effect of circumcision on HPV incidence and prevalence in men?
#* Reduced prevalence, no change in incidence
# What are the medical indications for circumcision?
## Recurrent balanitis
## Recurrent UTI
## Phimosis associated with lichen sclerosis
## True pathological scarring
# What are the contraindications to circumcision?
## Congenital penile deformity (epispadias, hypospadias, penoscrotal webbing, concealed penis, dorsal hood deformity, ventral curvature)
## Uncontrolled coagulopathy; however, children with blood dyscrasias can undergo circumcision, under appropriate treatment and care
# What is the most effective technique to achieve anesthesia for circumcision?
#* Dorsal penile nerve and ring block
# List potential complications related to circumcision
## Bleeding
## Infection
## Wound separation
## Poor cosmesis
## Meatal stenosis
## Glans amputation and necrosis
## Inclusion cysts
## Adhesions and skin bridges
## Suture sinus tracts
## Ventral curvature
## Secondary buried penis and phimosis
## Urethrocutaneous fisulae