Parent & Patient Information System 06/09/2015 Page33 / 51 Chapter 7 - Penile Problems Circumcision Circumcision is excision of a part of the skin (prepucium) which is covering the distal part of the penis (glans). It is performed regarding the cultural, religious or medical reasons. Glans and prepucium are attached to each other during the normal penile development. Most the newborns have these attachments. 75% of the boys younger than 5 years old have adhesions and the frequency decreases with the increasing age. Between the glans and prepucium, white nodular structures, which can be seen and palpated, are called as ‘smegma’. Smegma is a physiologic formation which is secondary to the collection of fatty secretion by the inner side of prepucium. It resolves within the time and parents should not show an effort to clean this structure by releasing the attachments between glans and prepucium. Because, this manoeuver causes tearing of the surface of glans which heals with secondary adhesions. Circumcision is one of the most speculative surgical procedures which is performed for centuries. Circumcision is thought to be having a beneficial preventive effect against penile and cervix cancer, sexually transmitted diseases (including AIDS) and urinary tract infection. Except the cultural or religious reasons, the relative indications for circumcision are: balanitis (inflammation of glans), balanoposthitis (inflammation of glans and prepucium), phimosis, paraphimosis, very long prepucium, as a preventive measure in the geographical regions which AIDS and similar diseases are frequent, as a preventive measure against penile cancer, children with recurrent UTI, after penile traumas. The absolute indications are the balanitis xerotica obliterans (BXO) and pathological phimosis caused by recurrent episodes of balanitis/balanopostitis. BXO is a chronic skin disease characterized by the scarring of prepucium, glans and outer opening of the urethra. It can be seen in 1.5% of the children and the cause couldn’t be exactly explained. The timing of the elective circumcision is controversial. However, it should be performed whenever it is indicated. The cultural or religious circumcision should not be performed between 1.5-5 years of ages which is a critical period for the psychological development of the child. If circumcision will be done within this age interval, sedation or general anesthesia should be used.
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