Troubling Dx at urologist office...

[dkenagy]

My 7-month-old son has hydronephrosis bilaterally due to UPJ obstruction. At our last visit to "the best" ped urologist, he made sure to remind me not to let anyone retract my son's foreskin and warned me about the terrible things that would happen if someone did. Good, good... anyway, I was looking over the yellow copy of the diagnosis/insurance sheet thingy and he circled quite a few things on the sheet: hydronephrosis and UPJ obstruction (of course), but also "penile adhesions" and "phimosis". Aren't "penile adhesions" found NORMALLY in a pre-retractile INFANT?? And, there are NO symptoms of phimosis other than his foreskin being still connected to the glans... ?? Is he just setting the stage to start pushing circ? I thought he sounded pretty foreskin-friendly when he was telling me about protecting my son from others' prodding fingers, but these extra circles on the yellow sheet are really bothering me!

Tell me I'm over-reacting...

[Fellow Traveler]

Originally Posted by dkenagy

My 7-month-old son has hydronephrosis bilaterally due to UPJ obstruction. At our last visit to "the best" ped urologist, he made sure to remind me not to let anyone retract my son's foreskin and warned me about the terrible things that would happen if someone did. Good, good... anyway, I was looking over the yellow copy of the diagnosis/insurance sheet thingy and he circled quite a few things on the sheet: hydronephrosis and UPJ obstruction (of course), but also "penile adhesions" and "phimosis". Aren't "penile adhesions" found NORMALLY in a pre-retractile INFANT?? And, there are NO symptoms of phimosis other than his foreskin being still connected to the glans... ?? Is he just setting the stage to start pushing circ? I thought he sounded pretty foreskin-friendly when he was telling me about protecting my son from others' prodding fingers, but these extra circles on the yellow sheet are really bothering me!

Tell me I'm over-reacting...

Sounds a bit fishy to me. You are right, "adhesions" are there naturally and all boys have phimosis before they are retractable. This is congenital vs acquired phimosis. I think you should talk to him about it.

[yarngoddess]

Maybe this is some kind of way he bills the ins. Like he checked for these issues, or discussed it. My old ped had this sheet and if we talked about ANYTHING it was circled on this insurance paper. Like I asked about my son's testicles (couldn't find one) and she circled testicular asent(sp) or my conversation with her about diet she circled malnutrition.

I hope this is NOT setting you up for problems. I really hope things go well for your DS

[eepster]

Drs circle whatever they need to on those forms to get the insurance company to cover what ever tests/proceedures they want to do. Hopefully that doesn't include circ, and the Dr circled them for some other reason. Just say no if he suggestes it at some point, or if he tries to treat the "phimosis" with steriods or somesuch.

[beru]

Originally Posted by dkenagy

... anyway, I was looking over the yellow copy of the diagnosis/insurance sheet thingy and he circled quite a few things on the sheet: hydronephrosis and UPJ obstruction (of course), but also "penile adhesions" and "phimosis". ..

My doctor had to circle that when we came in to get my son's penis checked. (We were ignorant and didn't know you could get a 1/2 inch smegma curds under the foreskin. I thought they were always little tiny "pearls".) Anyway, after the doctor determined my son was normal, she still had to bill us...I personally think, though, that she should have put something like skin infection or something.

[mtchen79]

I think it should be okay, Drs do that when they code/bill for their services. When we go to the ped, they circle things like diaper rash or eczema even if my daughter barely has a skin rash and it wasn't addressed anything more as "Looks like she has a slight rash" with no further comment. I also work in healthcare (not urology or peds) and I put down codes for anything I observe during the exam even if the patient is actually and truly healthy, but I do not code for anything that isn't there. In the end, though, there does have to be some kind of code or diagnosis and sometimes there just aren't codes for a normal state (i.e healthy intact penis). I once had a patient ask me why he had a diagnosis of "giddiness" (which wasn't a diagnosis made by me but since I work in a hospital, I had access to all of his records by other docs there) and I had to explain to him that in medical terms, giddiness isn't what he thought it meant, that there was a medical definition to it different that what he thought it meant. Anyway, if your urologist is foreskin friendly with all of that advice, then I don't think he will be recommending circ just because he circled those words. Once your son's foreskin retracts in the future, I doubt he'll be circling those diagnoses.

[latinalonestar]

Yes, adhesions are normal b/c the foreskin is fused to keep contaminants out. Phimosis can not be diagnosed until adulthood b/c ALL infants are non-retractable. You could probably take some informational pamphlets to your urologist if you want to clear that up with him.

[dkenagy]

Thanks for the replies; I was without my computer during a move/over the holidays, so I apologize for not responding sooner.

Anyway, the more I thought about that urologist visit, the more that doc just gave me the heebie-jeebies. Not to mention the fact that his final analysis has been to not conduct testing that would for-sure tell us if it is actually UPJ obstruction or something else causing the hydronephrosis.... I am taking my son to see a highly recommended and purportedly foreskin-friendly nephrologist 2 hrs away at the end of the month. I won't be seeing Dr. Phimosis anymore.

[Yulia_R]

If I have to guess, it is just a silly (and b*tt covering) way of saying that he is not retractable (which IS normal)

[glongley]

Speaking of fraudulent use of the term phimosis, I noticed that one of the pediatricians at my hospital wrote on the diagnosis line of the consent form for a newborn circumcision she performed: "phimosis", as if it were an actual medical problem worthy of surgical correction. Grrrr....

Gillian

[fruitful womb]

Originally Posted by glongley

Speaking of fraudulent use of the term phimosis, I noticed that one of the pediatricians at my hospital wrote on the diagnosis line of the consent form for a newborn circumcision she performed: "phimosis", as if it were an actual medical problem worthy of surgical correction. Grrrr....

Gillian

That isn't good.

This is a problem because the lady who works at the insurance billing department is going to see this time after time. It will swade her into circing her future son(s).

I would address this issue as fraudulent. My advice to you (OP), is to confront your ds's doctor and the insurance company.