Editing External Genital Anomalies in Boys (section)

=== Prepuce (Foreskin) ===

==== Phimosis ====
* '''See CUA Circumcision Guidelines'''

==== Paraphimosis ====
* In most cases, manual compression of the glans with placement of distal traction on the edematous foreskin allows reduction of the paraphimotic ring
* Insert figure
* Other options include''':'''
*# Application of an iced glove for 5 minutes
*# Application of granulated sugar for 1-2 hours
*# Placement of multiple punctures in the edematous skin

==== Circumcision ====
* '''See CUA Circumcision Guidelines'''
* Potential benefits:
*# Reduced risk of '''Penile cancer'''
*# Reduced risk of '''UTIs'''
*# Reduced risk of '''Sexually transmitted diseases including HIV'''
*# Reduced risk of '''Phimosis'''
*# Reduced risk of '''Balanitis'''
* '''Contraindications (2):'''
*# '''Neonates with other penile conditions (hypospadias, penile curvature, dorsal hood deformity, buried penis, and webbed penis) that require surgical correction'''
*#* '''Other conditions commonly seen in neonates that should be taken into consideration are a large hydrocele or inguinal hernias, which are more likely to develop secondary phimosis, buried penis, and trapped penis.'''
*#* '''There should be complete separation of the prepuce from the glans and complete inspection of the meatus and the corona to confirm the absence of anomalies, including hypospadias.'''
*# '''Coagulopathy'''
* '''Techniques and devices for neonatal circumcision:'''
*# '''Gomco clamp'''
*# '''Mogen clamp'''
*# '''Plastibell device'''
* '''Complications (6):'''
** Risk of complications after circumcision: 0.2-5%
*# '''Bleeding'''
*#* '''Most common complication, occurs in 0.1%''' and is more common in older children
*#* '''Usually localized from the frenulum'''
*# '''Wound infection'''
*#* '''Rare complication'''
*#* '''Antibiotic ointment (e.g., bacitracin) after circumcision usually prevents its development'''
*# '''Penile skin complications'''
*#* '''Insufficient or asymmetrical excision can result in a cosmetic and social dilemma for the parents and child'''
*#* '''Excessive skin excision can result in:'''
*#*# '''Penile chordee''', torsion, and lateral deviation
*#*# '''Trapped penis''' from a cicatricial scar
*# '''Glanular adhesions and skin bridges'''
*#* Glanular adhesions and skin bridges, attachments of the glans and penile shaft, respectively, are common complications
*#* '''Both can occur in the well-circumcised penis and are''' '''usually the result of the physiologic retraction of the penis caused by a suprapubic fat pad and diaper irritation of the penis'''
*#* '''Management'''
*#** '''Persistent adhesions can be lysed in the office with the application of a topical analgesic such as EMLA cream'''
*#** '''Low-dose corticosteroids have been relatively unsuccessful in lysing adhesions'''
*# '''Meatal Stenosis'''
*#* The normal urethral meatus is:
*#** Age<4: 10 Fr
*#** Age 4-10: 12 Fr
*#** Age>10: 14 Fr
*#* '''Symptoms include:'''
*#*# '''Narrow, high-velocity stream'''
*#*# '''Urinary stream deviation, typically in an upward direction''' resulting from a meatal baffle or ventral web located at the inferior aspect of the meatus
*#*# '''Penile pain''' '''at the initiation of micturition'''
*# '''Penile Trauma'''
*#* '''Most serious complication'''
*#* '''Includes urethral injury, excision of the glans and/or penile shaft, and penile necrosis'''
*#** '''Urethral injury requires urethroplasty'''
*#** '''Excision of the glans can be repaired by suturing the excised tissue back to the penis, often without the need for microscopic repair'''
*#*** '''Good results if performed within 8 hours'''

==== Lichen sclerosis (Balanitis Xerotica Obliterans) ====
* '''See Penis and Urethra Surgery Chapter Notes'''
* '''Rare in children age <5 years'''
* '''At puberty, inability to retract the prepuce is the most common presentation'''
* Other presenting symptoms include:
** Local infection
** Irritation
** Discomfort after micturition
** Bleeding
** Occasionally acute urinary retention or urinary incontinence
* '''Circumcision is the preferred treatment along with meatotomy or meatoplasty if there is meatal involvement'''
** Children with meatal involvement should be observed post-operatively because of the risk of recurrent meatal stenosis
** The use of topical corticosteroids has had limited benefit to treat mild BXO of the prepuce with minimal scar formation