Penile anomalies and circumcision

Abstract

A detailed examination of the phallus should include evaluation of preputial anatomy and retractability, meatal position, the presence of penile curvature, and other abnormal tissue or scarring. Pathologic phimosis is diagnosed if there is evidence of scarring and thickening or is symptomatic causing irritation and infection. If a phimotic prepuce is forcefully retracted and not returned to its anatomic position, paraphimosis can develop: a surgical emergency. For pathologic phimosis, treatment with steroid ointment or surgery is required. For routine circumcisions in the newborn period, a clamping device may be used, but a traditional sleeve circumcision under anesthesia is performed in the older patient or patient with a penile anomaly. Complications of circumcision include bleeding, glanular injury, epidermal inclusion cysts, penile skin bridges, and meatal stenosis, all of which could require surgical correction. Hypospadias has a wide spectrum of disease, and treatment should be offered if there is a likely functional or cosmetic benefit. For most distal hypospadias procedures, chordee is first evaluated and corrected. The urethroplasty is then performed using a variation of a urethral plate tubularization technique followed by skin reconstruction.