Need HELP dealing with urologist...

[Dragonfly]

Ds - 3 years - has an undescended testicle and apparently a hernia, as well. He's going to have to have surgery. At our first meeting with the second urologist today (first one was a dud), I was actually feeling optimistic, until he started to retract ds' foreskin.

I told him to be careful, not to pull back too far, because ds does not retract yet and I watched carefully to make sure he didn't pull back any further than ds does himself on a regular basis. He then mentioned that he appears to have "a bit of phimosis" and that he would suggest that I have him circumcized during the surgery to spare him the risk of having to go under general anesthesia again at a later date. I said, "Yes. Well, we won't be doing that."

I could almost see his hackles go up and he said, "Don't get me wrong. I don't normally advocate circumcision for older children -- though I do advocate infant circumcision," at which point I'm thinking this can only turn out badly. He continued, "I'm just pretty certain that he's going to end up circumcized anyway so we might as well do it now instead of making him go through surgery again."

I said, "I understand your position. I don't agree with circumcision as a proactive measure and I know that 3 years is still pretty early for retraction. I don't feel that we should be cutting pieces of his body off of him 'just in case' he's going to need it done later."

He sort of scoffed and said, "Well I've seen newborn infants who have retracted already! There's no 'magic age' for it!" To which I replied, "Well, all children are different." He countered with, "Well, he needs to be able to retract by the time puberty hits." : I couldn't even respond to that miracle of logic -- it's not a problem unless he can't retract during puberty, yet he's concerned that a *3-year-old* isn't retracting yet?

So he backed off a bit and said he would prescribe a steroid cream and that I should put it on twice a day for the few weeks before the surgery and then, if his foreskin is not loosening up, he would "strongly urge" me to consider circumcision. I again made it clear that we would not be circumcizing.

I'm sort of in a bind here. Ds needs this surgery - not just because of the undescended testicle and hernia but also because he has to have his adenoids out soon, as he can no longer breathe through his nose. This is our second round of doctors - the first were thoroughly unaccommodating as far as coordinating the surgeries together and the urologist was just terrible all around.

This guy is very capable - has a great reputation - and is one of five pediatric urologists in the area. I'm also pretty certain that I'm stuck with him because my HMO isn't going to pay for another consult with another urologist. And, even if the HMO would pay, it would take us yet another month or more to get in with another specialist which means at least 2 more months of ds suffering with his adenoids. Basically, I feel like we're stuck.

So, I need to arm myself with information about phimosis and retraction in children. I need to read as much as I can over my school break so I can cut this guy off at the pass and also just for my own peace of mind and experience. (I've not really read much about complications in uncircumcised boys because I just assumed that ds would have a healthy and perfectly functioning foreskin - and I'm still not convinced that he doesn't).

If you all can bombard me with links, studies, whatever, I would SO appreciate it.

Also, if anyone has been through anything similar with a doctor, I'd really like to benefit from your wisdom. I'm thinking about having him sign something before the surgery stating that he understands that we are not consenting to circumcision and that he is not, under any circumstances, to remove my son's foreskin. I'm wondering if he would even sign something like that....

Finally, if anyone has experience with phimosis at around ds' age - well, I'm just *confused*. I need to determine whether it's even necessary to use this bloody steroid cream because he hasn't shown any signs of being ready to retract. I don't want to go through the struggle with him that I KNOW it's going to be if there's no reason for it. I mean, if I'm putting a steroid cream on a foreskin that's just not ready to retract -- well, what the heck is the point?!

Anyway, thanks . This was a *frustrating* morning!

[Mommiska]

Oh, Dragonfly - that guy sounds like a complete idiot. I'm so sorry you are stuck with him for your ds's surgery...

My first thought reading your post was what you suggested at the end - I would DEFINITELY have him sign something stating that you are UNDER NO CIRCUMSTANCES consenting to haver your ds circumcised and that you will sue anyone who removes your son's foreskin. And more than having him sign this - I would state all of this to him in front of at least 2-3 witnesses.

I would be scared to death that this idiot would circumcise without my consent, thinking he was helping.

As for this steriod cream - I wouldn't use that. My dh is intact, and he's told me that he wasn't fully retractable until he was in his mid-teens. And he's never had any problems at all...age of retractability is so variable, and it's perfectly normal for a 3 year old not to be fully retractable.

I'm sure others will be able to give you all the links/info/etc. that you need. But I just wanted to commiserate, and tell you that I definitely think you're instincts to have your doctor sign something stating 'no circumcision' are good ones.

[shelbean91]

I agree, get it in writing that you've heard his 'strong suggestion' about circ and are refusing. If your son leaves that OR without a foreskin, you will file a lawsuit. If you want to be extra sure, maybe you could have a lawyer draw up a form for you. Sometimes, having a legal doc instead of something from a parent carries more weight. Also, does your ped agree with you not circ'ing? If so, have him/her contact the urologist and explain he is not to circ. You can also contact your HMO directly, and ask how to make a notation in your file that ds is not to be cut. If the HMO will refuse to pay, the urologist will be less likely to do it against your will, IMO.

Regardless of what he feels is right and is recommending, you are the parent and get to make the decision.

I'm sure someone else will jump on here to confirm or clarify this, but I think true phimosos can't even be diagnosed until after puberty. I wouldn't worry about proving your point to someone who will not have his mind changed. He's gone through a billion hours of medical classes and you're just a lowly parent who knows nothing and needs to be told what to do (not my thoughts, just my thoughts on his thoughts). The most of an argument I would get into is 'we'll cross that bridge when we get to it'. Other than that, I would just say, 'it's not our decision, we'll not be having it done, thank you, end of discussion'.

I'm sorry you have to go through this. I hope all goes well with the surgery.

[colaga]

Hi,

I should start by saying that I am no expert in these matters, where I come from nobody's routinely circumcised. But I also know that the foreskin should not be pulled back in such a young child, especially by a doctor who has no foreskin himself and has no idea what it is like to have an intact penis.

My husband is intact, and I think he started retracting his foreskin at about 5 years of age. But.. it has always been quite tight for him, and even difficult to retract. He told me that he hated pulling it back for washing, because it was so tight it was uncomfortable.
As far as I know, no doctor had ever even suggested that it was a problem or that it needed surgical correction.

Believe it or not, since we got married the tightness has not been a problem, anymore. Foreskin must have stretched during a certain kind of a marital exercise, which usually takes place in marrieds. That's what we figured...
So, that's to prove that even a tight foreskin is no reason for surgical invasion. That's just my husband's experience; I can imagine that in some rare cases you really might need some sort of alteration (a little cut, not circumcision) performed. But almost certainly not in a boy who's only just 3.

Here's some links I have found:

http://www.contpeds.com/be_core/cont...forum0203.html

http://www.norm-uk.org/phimosis_clin...uidelines.html

http://www.netdoctor.co.uk/diseases/facts/phimosis.htm

http://www.netdoctor.co.uk/menshealt...rcumcision.htm

http://www.nhsdirect.nhs.uk/SelfHelp...eskinchild.asp

http://www.surgerydoor.co.uk/level2/...umcision.shtml

http://www.bbc.co.uk/health/ask_doct...phimosis.shtml

[TigerTail]

this is appalling. i would be having nightmares about letting this guy operate on my child. i don't think there is a chance in hell he will sign anything, and likely will refuse to do the surgery for such *difficult* parents. so good news, if he refuses, wouldn't the hmo have to pay for someone else to do it?

good luck, how scary to have to consider protecting your child from this horror while you ought to just be able to worry about the procedure that *needs* doing.

best of luck, suse

[somemama]

Did I miss something? It almost sounded like you said this guy--the urologist--would be taking out his adenoids, too. That's not what you said, right? So, why would delaying this surgery cause problems with his adenoids coming out?

I would have said, "If you circ my son, I will sue your a**." (Then I would have gotten kicked out right there.)

If it were my son, I would call Marilyn Milos of nocirc.org and get a recommendation for a foreskin-friendly doc in the area.

Personally, I couldn't let a doc I didn't trust operate on my child.

The main problem most intact boys will ever have with their foreskins is that someone THINKS they have a problem!

[Dragonfly]

Originally posted by mamajulie
Did I miss something? It almost sounded like you said this guy--the urologist--would be taking out his adenoids, too. That's not what you said, right? So, why would delaying this surgery cause problems with his adenoids coming out?

Because I want to have them both done at once so he doesn't have to go under anesthesia twice. The healing from both is supposed to be relatively "easy", so I'd prefer to save him the trauma of going through two surgeries. And, no, it's an ENT that's removing his adenoids.

Personally, I couldn't let a doc I didn't trust operate on my child.

Yeah, unfortunately I'm not rich and it's looking like with my insurance it's either this guy, or the last one (who was worse), or no one at all. Believe me, I'm not at all wild about it. And I have no qualms about looking him in the eye and telling him that he won't be touching my son's foreskin. Actually, I believe I did that twice already......

[Dragonfly]

Originally posted by Hilary
Why can he no longer breathe?

Because his adenoids are blocking his nasopharyngeal passageway almost completely at this point.

Have you investigated whether he is allergic to dairy foods?

He is. He doesn't eat dairy. He was having some occasionally for awhile (cheese, not milk) but started having sinus issues, so I took him off it completely.

I've done a good bit of reading about the adenoids. Trust me, I want to avoid surgery for him at all costs - particularly when it involves removing a part of his body.

Has he had antibiotics?

He's had one round - to clear up a chronic sinus infection that was diagnosed at the same time as his enlarged adenoids.

Vaccines?

Nope. None, never.

There are a lot of things that IMO need to be thought about, before discussing the issue of an undescended testical and hernia.

I'm willing to bet that I've thought of a good many of them. But I'm happy to hear any other thoughts you have...

My guess with his adenoids is it's either fairly normal swelling (because it's apparently normal for adenoids to swell up during this stage in childhood anyway) that is a problem because of his internal structure (which sometimes happens, as I understand, and wouldn't be surprising since this is the case with his father and was the case with me, as well). Either that or it's some sort of environmental allergen - perhaps mold. And, unfortunately, I'm just not really sure what to do about that. But, like I said, if you have suggestions, I'm game.

In the meantime, I will look for some good links I saw elsewhere, and come back and put them up later.

Thanks

[Dragonfly]

I just wanted to say - in keeping with my new-fangled policy to try to find something positive in everything - this guy really made me realize how much of an intactivist I'm becoming. And how far I've come in advocating for what I believe is important (especially my son!).

Anyway...

Thanks for the thoughts, everybody!

[Quirky]

OH....MY....FREAKIN'...WORD. What an off-pissing situation! What a jerk!!

I would DEFINITELY get it in writing that he is not to circumcise your son under ANY circumstances. I don't think you need to be obnoxious about it and lawyer up or anything, but he needs to sign something (and I agree that contacting your HMO is a good idea too).

He is totally out to lunch on the "phimosis" thing. Hardly surprising, given that he advocates routine infant circ. (Gee, not even the AAP does that!) I would NOT do the steroid cream. No need, and it could be harmful.

Here are some links:

http://www.cirp.org/library/normal/

http://www.cirp.org/library/treatment/phimosis/

http://www.mothering.com/10-0-0/html...rcson103.shtml

http://mothersagainstcirc.org/later.htm

Good luck trying to educate this turkey, if you go that route. I don't think you need to try too hard; he makes a living cutting off foreskins, so his mind is made up. You do need to get him to sign a statement that he will not circ under any circumstances whatsover.

[Dragonfly]

Originally posted by Jane
He is totally out to lunch on the "phimosis" thing. Hardly surprising, given that he advocates routine infant circ. (Gee, not even the AAP does that!) I would NOT do the steroid cream. No need, and it could be harmful.

Thanks Jane! This is what my gut was telling me (about the steroid cream), but there's still this little part of me that's been going, "What if there really *is* a problem?" :

Yeah, and trying to change his mind? No way am I banging my head against that brick wall. I just want to know my stuff so I don't feel bulldozed by him - just the way I empower myself - and so I can make decisions confidently.

It's tough. I do trust that he'll do a great job with ds' testicle and with the hernia. My concern now is to make sure he knows that if he messes with his foreskin, he'll be a sorry, sorry man.

Going to look at the links everyone's dished out. You guys are great!

[Quirky]

Originally posted by Dragonfly
My concern now is to make sure he knows that if he messes with his foreskin, he'll be a sorry, sorry man.

Yes, indeedy. Be a good, compliant doctor or you will regret it.

I'll be happy to look it up in my copy of Dr. Fleiss' What Your Doctor May Not Tell You About Circumcision and scan/email you the pages if you want - he's got tons of references. But probably everything you need is in the links.

[Quickening]

Sounds like the women here have the information for you! I have one suggestion made by Dr Robert Mendelsohn in one of his books. He says to have your child's ped attend surgery as an observer to make SURE nothing untoward happens like medical students "having a go" or unnecessary procedures etc.

I really strongly recommend this because don't you know, doctors are GOD! The all powerful almighty saviour whatever : and you really don't want to risk it. What is done is done and this bastard may adopt that sort of attitude and circumcize your son and there will be nothing you can do to reverse that!

*pokes Hilary* hurry up with that additional info

[G-ZA]

Originally posted by Dragonfly
Thanks Jane! This is what my gut was telling me (about the steroid cream), but there's still this little part of me that's been going, "What if there really *is* a problem?" :

Don't worry about it. If there *is* really a problem, deal with it at the appropriate time - in your son's teens. The quack suggesting that the foreskin *should* be retractible at 3 is ridiculous.

It might be an idea to take along some documentation - like the statements from all the major medical organisations - and suggest that he educates himself.

[Frankly Speaking]

You've gotten a lot of good and accurate advise here. What a shame you have to come to a web discussion board to get accurate information from non-medical types when the medical types are spewing such bad information!

Forget phimosis! If there had been any indications of phimosis, you would have mentioned them. Phimosis is the result of scarring from repeated infections. No infections, . . . . No phimosis! Here is a page you can print out for this idiot:

http://www.mja.com.au/public/issues/...w10610_fm.html

It will clearly show him how to diagnose phimosis. At the same time, hand him an invoice for the education you are having to give him to protect your son and other mother's sons. What a moron!

Throw the steroid ointment away. He certainly doesn't need it now if he ever needs it. Trying to use that stuff can do more harm than good at this age.

When you go for the procedure, you will have to sign a consent form for the procedure. Take a large Majic Marker with you and on every sheet of the consent form, write "No Circumcision" and make sure they give you a photocopy of it. If they refuse to give you a copy or refuse to accept the marked up copy, you can be assured that they plan to circumcise your son. That's when you walk out.

When you sign that consent form, you give up almost all of your legal rights. They are permitted to do as they wish and if they want to circumcise, they can say it was a necessary part of the procedure. At that point, all you can do is sue the jerk. You then have to prove that the circumcision was not a necessary part of the hernia operation.

Don't think these things can happen? There was recently a story on the Discovery Channel about "ambiguous genitalia." There was a boy who had this condition and the doctors had been urging the parents to have a sex change operation preformed. They had steadfastly refused. The doctor told them at a normal checkup that these boys were at risk of testicular cancer and he needed to do a biopsy to test for this cancer. They signed the consent form for the procedure with the clear understanding that there would be nothing more than a biopsy. When the doctor came back out, he said that the boy’s testicle was cancerous and they had to castrate him. The mother snatched the paperwork out of the doctors hand and there in the lab report it showed no sign of cancer at all! This doctor was so intent in changing this boy’s sex that he castrated him thinking that would make it inevitable! The consent form had given the doctor the authorization to castrate the boy and the doctor didn’t dream the mother would ever see the lab report!

Step carefully with this jerk!




Frank

[Dragonfly]

Originally posted by Quickening
Sounds like the women here have the information for you! I have one suggestion made by Dr Robert Mendelsohn in one of his books. He says to have your child's ped attend surgery as an observer to make SURE nothing untoward happens like medical students "having a go" or unnecessary procedures etc.

This is an *excellent* idea! I'm going to talk to her about it ASAP. He has a great ped who I feel I can definitely trust to stand up for him - and his foreskin (helps that she's European, I think)!

I'm also going to do the big black marker thing - about circumcision and the medical students working on him. And I'm going to see if there's a way I can observe the surgery.

[dot2dot]

I am sorry for going off topic and back to the adenoid things but I am just curious about getting them removed at so young of an age? I know nothing about this except through my brother who has always had allergies and breathing problems. When he was young, his doctor said that he prefered to wait until after people stopped growing to do any surgery because of how everything is still growing and changing. My brother did end up having the surgery in college but I just wondered, do not all doctors prefer to wait or is it just a really really really bad case?
Oh, I think it was a deviated septum that was also his problem... maybe that is what his dr. was referring to. Sorry again. Leaving now!

[AnnMarie]

I would run from that doctor. Your son could end up circed if you let him do the surgery. It's happened before. If you do go with him write on EVERY paper that you sign, "No foreskin retraction or circumcision!"

I would not use that cream either. Your son's foreskin is totally normal. It's the doctor that's not.

Good luck with the surgery!

[Frankly Speaking]

Somebody please tell me if I'm wrong. I seem to remember reading somewhere that an undescended testicle that is not repaired is a risk factor for cancer later in life. Do I remember that correctly or am I all wet?




Frank

[AnnMarie]

Originally posted by Hilary

He was surprised that they would advocate surgery for a descended testicle. After all, lots of people have lived long and rich lives with only one descended testicle. Sure, it means that that testicle isn't fertile. But unless a disaster occurs, your son could populate the rest of the world with the other one

My son has an undescended testicle and I've gotten lots of grief from people for not having the surgery done. None of our doctors ever said a word about it.