4-year old just diagnosed with phimosis today. Please help? - Page 2

[MCatLvrMom2A&X]

That is funny that you say that pumpkinhead as I was under the impression that was the first step always in finding out what is growing there be it yeast or bacteria. I know it is the first thing we tell parents to have done if they suspect an infection.

I know the skin always has bacteria but on the tests they run I am sure they would know if it was normal or if the numbers where higher than normal and be able to tell if it needs treatment or not.

The only way to get a culture without causing harm is to touch the swab to the tip of the foreskin without retracting. So that is the only possible way to get a culture of possible infection.

[Jeff B]

Someone with the Utah Birth Network may know of a doctor in your area who knows about proper care for intact boys.

http://www.utahbirth.net/

[Yulia_R]

The doctor is 100% wrong, most of boys are still not retractable at 4. My son is 3.5 and is not anywhere near to being retractable. It is TOTALLY normal to not retract till much later.

Steriod cream will not help, forskin will reatach as soon as you stop using it and will retract when it is RIGHT TIME for your boy.

If someone manipulated his foreskin (let's say another doctor) it could create micro-tears and actually CAUSE this infection. Even if it is infection, it's easily treatable with antibiotic and does not require amputative sergery (would you amputate your son's finger if it got infected??). If your son is treated with antibiotics, make sure you keep him on good probiotics, at least 10 billions a day for at least a month after that to prevent yeast taking over (it's not just for intact boys, but for all people to keep gut flora healthy while being treated with antibiotics).

Make sure no doctor ever manipulates his foreskin
A Warning For Parents of Intact Sons http://www.mothering.com/discussions...d.php?t=129378

[Yulia_R]

And one more point. Does your son actually had a discharge from his penis? Did the doctor take a culture it? In case your son just had a swolen, red penis with no discharge, it could be a separation trauma which usually resolves on its own within 48 hours.

[pumpkinhead]

Originally Posted by MCatLvrMom2A&X

That is funny that you say that pumpkinhead as I was under the impression that was the first step always in finding out what is growing there be it yeast or bacteria. I know it is the first thing we tell parents to have done if they suspect an infection.

I know the skin always has bacteria but on the tests they run I am sure they would know if it was normal or if the numbers where higher than normal and be able to tell if it needs treatment or not.

The only way to get a culture without causing harm is to touch the swab to the tip of the foreskin without retracting. So that is the only possible way to get a culture of possible infection.

The thing is, even with selective media, a culture of the foreskin is always going to grow something. It's really not a good diagnostic tool. It could grow a whole whack of E.coli or even aspergillus, but these might not be what is causing the infection.

If you can clean the area with alcohol or something and then get a clean swab of only the pus, that might tell you something.

What I am saying is that taking a culture of the foreskin really isn't going to tell you definitively what is causing the infection. As a complete last resport it might be useful, but not as a first step. If you're looking for something that really shouldn't be there like group A strep or chlamydia, a swab and selective media will give you that information.

My way of thinking mirrored yours until recently. I had the opportunity to work in the central infectious diseases micro lab at a local hospital for a 6 month term. I learned a lot.

[A&A]

Originally Posted by Friday13th

It's really, REALLY, REALLY normal for boys to not be retractable at four. Some don't retract until they're teenagers. Assuming he can pee, there is no reason to be using a steroid cream.

Also, urologists in the US pretty much only know how to do one thing with the foreskin-cut it off so I would not be taking his opinion seriously.

Did they do a culture for the bacterical infection? They should have. And btw, not being retractable has NOTHING to do with an infection. I'd run far and fast from that doctor.

:

[A&A]

PS. Where in Utah are you? Dr. Justin Alvey at WeeCare Pediatrics in Kaysville is foreskin friendly!!!

I personally know five intact Utah boys. It is changing, even in this state. You know how you create more intact Utah boys? You educate pregnant mamas!!

[MCatLvrMom2A&X]

I definatly see what you are saying pumpkinhead. Thank you for explaining it more

[AleksFeodoraSnyder]

I have an 19 mo. old that has a similar problem...

Hi,
I have a 19 mo. old that has a similar problem. He is 19 months old now. At around 1 year he had a UTI, due to trapped urine in his forskin. They suggested then that he would probably need a circumcision. I was really against it, and the doctor gave us an alternative to the procedure, he gave us a cream that was supposed to help loosen the forskin. However, once we stop the cream the forskin becomes really tight.
When our son was born, all the "what to expecting, when you are expecting" books directed us to not touch his forskin or pull it back, so as to not harm it. My husband is circumcised, so we followed those directions. When our son got the UTI, The Doctor told us that our son has a lot of scar tissue (probably due to repeated infections unbeknowest to us) [Maybe we should have lifted the forskin back to get the last dribbles out?] that has developed into a ring, he and his assistant had a hard time finding the opening to the urinary tract when they wanted to test his urine for a culture. The doctor confirmed that it wasn't his kidneys, or anything else. The UTI was probably caused by trapped urine and the resulting bacteria. I've waited 6 months in the hopes that the cream and "massage" helped my son's forskin. However, his forskin once we stop using the cream shrinks into a tiny ring where you can't even see the opening to the urinary tract. He can still pee, but it dribbles to the side.
I don't want my son to get another UTI, last time it was very scary, he had blood in his urine, lots of doctors visits, and just a lot of stress.
I am from a culture/religion that it is very important to stay intact, and i am getting a lot of "peer" pressure from my sister-in-law that the doctor is "full" of it (she hasn't seen my son's ring, she lives far away), and everything i read says that a lot of circumcisions are done unessarily. Some of that literature has confused me, and made me wait this long. I've come to the conclusion that there are a lot of "intact" advocates out there, and when someone (like my son) who really needs this procedure, might be waiting longer than they should.
Does anyone know of some medical literature out there that suggests keeping the forskin when the urinary tract is partially obstructed? Is it possible to keep him intact? Am i doing the right thing by scheduling his circumsion?

Thanks, A.

[Yulia_R]

Your son does not need a circ, but rather a new good pediatrician.

AleksFeodoraSnyder, let me ask you a question: how could the doctor know about the scar tissue? Did he retract your son??

Also ask your doctor if a little girl came in with a UTI would he blame it on "her urine being trapped in vagina"??? or would he just tell her parents that UTI do happen, give her antibiotics, warn the parents to not let her have bubble/soapy baths and that would have been all there is to it?

By "trapped in the foreskin urine" I assume the doctor meant balloning which is TOTALLY normal (some boys have it others don't, but it is 100% normal stage in a separation process) and does not cause UTIs.

As long as he can pee he's fine. Foreskin does sometimes direct urine into funny directions and this is normal as well.

The opening is SUPPOSED to be tiny in babies/young boys, it opens up a little during urination and then closes back up tightly right after that. This is 100% normal and is a nature's way to protect the glans from bacteria coming in.

As long as your son can pee, he is FINE and NO one should ever mess with his foreskin except him himself.

The doctors doesn’t seem to be knowledgeable on the issue; of course the foreskin would re-adhere back to the glans once steroid cream is discontinued, what else would he expect??? Once again, TOTALLY normal. It will separate in its own time, the opening will loosen up in it’s own time as a last step of the separation process.

[eepster]

Originally Posted by AleksFeodoraSnyder

Hi,
I have a 19 mo. old that has a similar problem. He is 19 months old now. At around 1 year he had a UTI, due to trapped urine in his forskin. They suggested then that he would probably need a circumcision. I was really against it, and the doctor gave us an alternative to the procedure, he gave us a cream that was supposed to help loosen the forskin. However, once we stop the cream the forskin becomes really tight.
When our son was born, all the "what to expecting, when you are expecting" books directed us to not touch his forskin or pull it back, so as to not harm it. My husband is circumcised, so we followed those directions. When our son got the UTI, The Doctor told us that our son has a lot of scar tissue (probably due to repeated infections unbeknowest to us) [Maybe we should have lifted the forskin back to get the last dribbles out?] that has developed into a ring, he and his assistant had a hard time finding the opening to the urinary tract when they wanted to test his urine for a culture. The doctor confirmed that it wasn't his kidneys, or anything else. The UTI was probably caused by trapped urine and the resulting bacteria. I've waited 6 months in the hopes that the cream and "massage" helped my son's forskin. However, his forskin once we stop using the cream shrinks into a tiny ring where you can't even see the opening to the urinary tract. He can still pee, but it dribbles to the side.
I don't want my son to get another UTI, last time it was very scary, he had blood in his urine, lots of doctors visits, and just a lot of stress.
I am from a culture/religion that it is very important to stay intact, and i am getting a lot of "peer" pressure from my sister-in-law that the doctor is "full" of it (she hasn't seen my son's ring, she lives far away), and everything i read says that a lot of circumcisions are done unessarily. Some of that literature has confused me, and made me wait this long. I've come to the conclusion that there are a lot of "intact" advocates out there, and when someone (like my son) who really needs this procedure, might be waiting longer than they should.
Does anyone know of some medical literature out there that suggests keeping the forskin when the urinary tract is partially obstructed? Is it possible to keep him intact? Am i doing the right thing by scheduling his circumsion?

Thanks, A.

Even if your DS truely does have true phimosis (very rare) there are much much less drastic treatments than circucision, which is the complete amputation pf the foreskin.

The steriod treatment is meant for adult men who have nonretractable foreskins (which is usually caused by repeated forced retraction during infancy.) It is only effective on adult men and needs to be combined with excercises that are inapropriate to do on a baby.

The most drastic treatment I would suggest any parent agree to in a situation like yours would be a dorsal slit, and I think it's highly unlikely that even that is necessary.

It is obviuosly impossible for any of us to dx your DS over the internet, but realize that we have heard story after story of Drs reccomending circ for what are just parts of normal development.

The first things we need to know are:

Why did you suspect UTI to begin with?
Does he cry as he pees (either now or when he had the UTI?)
How were these UTIs dx'd?
Has anyone ever retracted him?
Does he fill diapers or potties with pee?


BTW, starting a new thread will get you more responses, and to MDC.

[Yulia_R]

Originally Posted by eepster

the steriod treatment is meant for adult men who have nonretractable foreskins (which is usually caused by repeated forced retraction during infancy.) it is only effective on adult men and needs to be combined with excercises that are inapropriate to do on a baby

exactly!

[AleksFeodoraSnyder]

scar tissue

The doctor showed us the scar tissue. He showed us on the opening of the forskin where the skin has fused, leaving the tiny opening. He didn't pull back the forskin severly. Just to show us the scar tissue. The opening you can tell, used to be much wider and the skin was fused together at the edges.

[eepster]

Originally Posted by AleksFeodoraSnyder

The doctor showed us the scar tissue. He showed us on the opening of the forskin where the skin has fused, leaving the tiny opening. He didn't pull back the forskin severly. Just to show us the scar tissue. The opening you can tell, used to be much wider and the skin was fused together at the edges.

There is a sphincter at the end of the foreskin which opens and closes. When the Dr messed with it, your DS will have naturally closed it, the same way he would have blinked if the Dr waas messing with his eyelid.

[Yulia_R]

Originally Posted by AleksFeodoraSnyder

The doctor showed us the scar tissue. He showed us on the opening of the forskin where the skin has fused, leaving the tiny opening. He didn't pull back the forskin severly. Just to show us the scar tissue. The opening you can tell, used to be much wider and the skin was fused together at the edges.

The way you described it sounds 100% normal to me, this is exactly how the tip of my son's penis look like. Some boys do have wider opening and some have a very tiny one; both are totally normal. Rigid band, which is on the very tip of foreskin, looks just like you described in some boys. Before they are retractable, it looks sort of like a tiny glued together, wrinkled skin and once again is totally normal. By the way, Rigid band is the MOST sensitive part of the penis.

It is NOT ok for the doctor to retract even slightly. Make sure you read this thread:

A Warning to Parents With Intact Sons http://www.mothering.com/discussions....php?t=1050941

[AleksFeodoraSnyder]

We and the doctor suspected UTI because there was blood in his urine. He cried when he went pee, he lifted his legs with pain.

Now he hates diaper changes and has a pink occationally inflamed forskin tip. (he doesn't appear to be in pain).

The UTI was diagnosed with a culture from a sample of urine retrieved from a catheter.

He is in daycare, i don't know if someone has retracted his forskin there. I haven't nor has my husband retracted his forskin.

He has plenty of pee and poopey diapers.

[Yulia_R]

Originally Posted by eepster

There is a sphincter at the end of the foreskin which opens and closes. When the Dr messed with it, your DS will have naturally closed it, the same way he would have blinked if the Dr waas messing with his eyelid.

yep, that's right. The sphincter usually opens during urination (just enough for urine to pass through), closing up tightly right after it, keeping glans protected from all sort of stuff: bacteria, poop, dirt, send, ect. The sphincter is very similar to our anus.

[AleksFeodoraSnyder]

Originally Posted by Yulia_R

The way you described it sounds 100% normal to me, this is exactly how the tip of my son's penis look like. Some boys do have wider opening and some have a very tiny one; both are totally normal. Rigid band, which is on the very tip of foreskin, looks just like you described in some boys. Before they are retractable, it looks sort of like a tiny glued together, wrinkled skin and once again is totally normal. By the way, Rigid band is the MOST sensitive part of the penis.

It is NOT ok for the doctor to retract even slightly. Make sure you read this thread:

A Warning to Parents With Intact Sons http://www.mothering.com/discussions....php?t=1050941

Re: Rigid band. In my son the tip looks like the sides of the opening are fused/glued with a line of discolored tissue, and then a little bit of of puffed skin at the end. It's not totally fused to the end. What kind of medical article do you know of that shows what you are describing?
A.

My son's penis looks very similar to the photo in this website: http://www.steadyhealth.com/articles..._a574_f27.html

[Yulia_R]

Originally Posted by AleksFeodoraSnyder

We and the doctor suspected UTI because there was blood in his urine. He cried when he went pee, he lifted his legs with pain.

Now he hates diaper changes and has a pink occationally inflamed forskin tip. (he doesn't appear to be in pain).

The UTI was diagnosed with a culture from a sample of urine retrieved from a catheter.

He is in daycare, i don't know if someone has retracted his forskin there. I haven't nor has my husband retracted his forskin.

He has plenty of pee and poopey diapers.

UTI do happen. Girls have much higher chance of getting them, by the way (and no one suggests to circ them). Some kids are more prone to them than others (for example, one kid can be just fine with bubble baths and another one would get a UTI after each bubble bath; some people can swim in cold water just fine and I personally would pee blood within 12 hours of swimming in very cold water...everyone is different). One thing is for sure, that foreskin is NOT to blame for it. If UTI did happen, you treat it (making sure to give your son probiotics for a while if he had to take antibiotics), you try to stay away from possible triggers and this is all you can do. Circ’d boys get UTI just as well.

Occasionally pink (redish) tip is NORMAL. Just give him some diaper free time.

[Friday13th]

I just want to agree with PP, your son sounds completely normal. He does not need to be retractible at this age, the doctor does not need to be able to see the opening of his urethra.