8 wk old uncirc'd DS had to have catheter

[heartandhands]

Hi. Our DS requires some tests that req catheterization. It was done once to him today and will have to be repeated on Thursday or Friday. They obviously had to retract the foreskin all the way back. I thought I was going to faint watching this. They said they had to do it to get the catheter in. Is my son's penis going to be damaged? I'm so distraught. I never thought of this issue when we decided not to circumcise. It was never even an option in my mind. However, I am thinking it would have caused fewer problems if we'd just done it. Please tell me he's going to be okay. I'm sick to my stomach with this worry but he must have the diagnostic procedure done in order to figure out a bigger more pressing health issue.

[pacificbliss]

Poor baby, and poor mama. I found this quote at doctorsopposingcircumcision,com, "It is important to apply 4x/day Vaseline to the glans and inner foreskin for several weeks until the damaged tissue heals. This may prevent unnatural adhesions, (there are no guarantees) and importantly, may keep the child’s foreskin from becoming scarred and inelastic."

I don't recommend you read the site as it will not be comforting at this point. The site also mentions that catheterization can generally be done by "feel" with a complete retraction being unnecessary. Maybe they can be gentler to him at the next appointment? I did not research this site, I just did a google search for you. Hopefully mamas here will have some advice.



Mods, I did not see a sticky on caring for a forcibly retracted foreskin. Did I miss it?

[MommytoB]

Why does your DS need catheterization and here is some information on this

Would my son's foreskin need to be retracted if he were catheterized for a urinalysis or medical treatment?
No. A catheter can be inserted when the foreskin is retracted just enough to see the meatus (urinary opening). if the foreskin's opening is too small to retract far enough to see the meatus, a catheter can be inserted through the foreskin's opening and into the meatus "by feel." The foreskin should never be retracted by force for any reason.

http://www.nocirc.org/publish/pamphlet6.html

[philomom]

Why all the way back? Why not just the tip to expose the opening/urethra? Poor little fellow.

[an_aurora]

Next time, do NOT let them retract your son. It's unnecessary, it's damaging and it is very painful.

Instruct them to pull the foreskin away from the body, clean with the swabs, and then insert the cath. It's much easier to visualize the meatus, and the cath tip slides right in.

[eepster]

Retraction is completely unnecessary and risky.

If the nurse/tech doing the insertion says that it isn't possible to do it without retracting, then ask for a different nurse/tech. Nicu nurses and nurses who went to school in non-circing countries (there are a lot of Irish nurses around here,) generally know how to do it correctly.

Your DS should recover from todays trauma pretty soon. Keep an eye out for infection. There may be some swelling and redness tomorrow.

Just b/c he will probably be OK does not mean it is OK for it to happen again though. Repeated injury can lead to true adhesions of phimosis (both are treatable without circ BTW, but why not avoid them if possible.) Also when the foreskin is prematurely retracted there is a risk of it causing paraphimosis.

[glongley]

Originally Posted by pacificbliss

I found this quote at doctorsopposingcircumcision,com, "It is important to apply 4x/day Vaseline to the glans and inner foreskin for several weeks until the damaged tissue heals. This may prevent unnatural adhesions, (there are no guarantees) and importantly, may keep the child’s foreskin from becoming scarred and inelastic."

I would ignore any advice to keep retracting the foreskin to apply Vaseline or whatever. It will only add additional physical and emotional trauma. I believe DOC has updated its recommendation to leave the prematurely retracted foreskin alone and simply observe for signs of infection. See their most recent statement of the rationale for this approach in this following article:

http://www.kindredcommunity.com/arti...actions/p/1253

"If your child has been forcibly retracted, some experts suggest creating a barrier between the raw surfaces by gentle separation and the use of an oil-based cream to prevent the surfaces from adhering abnormally. But this is also very painful for the child, psychologically challenging, and holds no guarantee of success. Other experts suggest that it is better, physically and psychologically, to leave the boy alone and allow his natural healing powers to take over. Studies do show that adhesions from circumcision, for instance, tend to resolve spontaneously.18 This theory holds that the psychological effect of further, repeated, painful, and traumatic handling of the boy's genitalia may not be worth the effort or risk."

Gillian

[Quirky]

DO NOT LET THEM RETRACT HIM FULLY AGAIN ON THURSDAY OR FRIDAY!!!

What they did was harmful and unnecessary. INSIST that they get someone in there who knows what they're doing. Like a NICU nurse or someone who will only gently flare the foreskin against the glans enough to visualize the meatus.

It simply did not need to be done and even though it's been done once SHOULD NOT be done again.

Do whatever you have to do to make sure it doesn't happen again!

[ElliesMomma]

good advice above, and -- despite this happening -- it WAS and IS still the RIGHT THING that your son has a foreskin! having a circumcision would not be preferable to this situation.

[eepster]

Originally Posted by ElliesMomma

good advice above, and -- despite this happening -- it WAS and IS still the RIGHT THING that your son has a foreskin! having a circumcision would not be preferable to this situation.

Yes! Premature separation and forceful retraction is actually the first step when doing a circ, so circ'ing does not avoid it occurring, it just guarantees that it will happen sooner.

[heartandhands]

I am truly freaking out now. I asked the nurse but she said it's hospital policy. Exactly what am I dealing with in terms of risks to my son's penis health? I assume he's going to have the same thing done on Thursday bc it's their policy-abd I already saw the chart which says we are "anxious parents" and I don't want to jeopardize our care here. Don't get me wrong, I advocate for my children. I did that so much at the last hospital before we were transferred here, that the ped hated us. I am sick to my stomach already with my son's condition and now I have to worry about this. They said partial retraction would not be as sterile a technique and they needed it sterile to collect the urine. Oh Lord, I'm so upset. I don't want him to have a dysfunctional penis. Is that what could happen? I'm sick just thinking about it. Should I get him circ'd before this procedure is carried out? I mean assuming they refuse to alter their technique, is it better at this point to circ him and avoid damage?? Would he even heal from that in time for the cath insertion later this week? I am just not sure I will get someone who will be willing/capable of cath'ing w/o forcing it back all the way. Can anyone cite Neva specific article on this bc I can not go looking. I am too stressed out and upset. Thank you

[serendipity22]

Stop worrying

Should I get him circ'd before this procedure is carried out? I mean assuming they refuse to alter their technique, is it better at this point to circ him and avoid damage??

Circ does way way more damage than retraction ever could.

Please relax and stop worrying. Stress is waste of energy and it prevents one from thinking clearly.

Its never too late to change doctors or change hospitals.

he must have the diagnostic procedure done in order to figure out a bigger more pressing health issue.

And the more pressing health issue is?

My 2 year old son is not circed. Its a non-issue. We do nothing. We never worry about.

Why did you take your son back to the hospital?

[MCatLvrMom2A&X]

Repeat forced retraction is what causes issues. If you get someone to do the cath from the NICU they should know exactly how to do it without retracting. I would not allow the test again without them not retracting. There is no need for it and it can cause a lot of damage not to mention infection.

Do not keep retracting yourself and let his body heal the damage that was done.

Having him circed will just do way more damage. Just stand firm and dont worry about what the Dr. thinks about you. Your first priority is your ds. What the Dr. thinks is not important.

[mamadelbosque]

Just another vote for unneccasary... My ds2 had UTI at 2wks and was cath'd at a month or two (forget when exactly now) to check his kidneys out and they did not have to retract him to do so. Get a different nurse/doctor.

[Quirky]

Absolutely you should not have him circed to prevent harm to the foreskin --- because circumcision will be far worse!

Mama, deep cleansing breaths first of all. You did the right thing by keeping him intact and you have not failed to protect him -- you weren't as educated as you are now even a week ago about the intact penis, and by the time you finish educating yourself here and with the resources you have, you will know MORE than the ignorant health care professionals about the intact penis.

First things first: you should not go forward with this procedure until you are guaranteed that they will not retract him again.

There's nothing life-threatening going on, right? I assume if this were life-threatening he'd be in the hospital right now. So you do have a little time to reschedule if necessary and educate yourself and figure out what your options are.

Here is the deal about the intact penis -- it is not a germ-ridden ticking time bomb. The infant foreskin is sealed to the glans by synechial tissue, the exact same type of tissue that bonds your fingernails to your nailbeds. This is precisely so pathogens will not enter the preputial space (the space between the foreskin, or prepuce, and the glans (head) where the urethra opens (meatus)).

So retraction is simply not necessary to avoid "germs" because the foreskin itself keeps harmful germs out of the urinary tract. The sphincter at the end of the foreskin opens to allow urine out upon urination, and closes up again to seal the penis off and protect the urethra.

Assuming your son is breastfed, and assuming he was born vaginally, he's colonized with beneficial bacteria from you and from your breastmilk and those beneficial bacteria as well as the other protective components of breastmilk do more to protect him from a urinary tract infection than anything else.

In an intact man who's fully retractable, because the synechial tissue has broken down allowing separation of the foreskin from the glans, a "clean catch" urine sample or a catheterization would require at least partial retraction to allow cleaning of the glans, but it doesn't require scrubbing like you'd prep for surgery -- just cleansing like you'd do on a woman before doing a clean catch or cath.

But on an intact boy, there's simply no space for germs to inhabit any more than germs live between your attached fingernail (the pink part) and your nail bed. There's no open space for them to get in there.

Premature retraction is like ripping the fingernail off the nailbed. It's harmful and unnecessary -- you don't need to rip your fingernails entirely off to clean underneath the detached part of the nail, and you don't need to retract the entire foreskin to get a catheter into the intact penis.

An educated and informed health care provider should know about the intact penis and the harms of premature retraction, and you should not let them bully or cow you into accepting out-of-date, uninformed, and harmful medical procedures. They don't know what they're talking about if they say full retraction is necessary, and you should calmly -- calmly but firmly -- insist that they do it your way, because that's the way they do it in every other medically advanced society where the intact penis is the norm.

I would contact Marilyn Milos at www.nocirc.org and John Geisheker or George Denniston at www.doctorsopposingcircumcision.org and see what resources they have for you in terms of finding another provider or better hospital, and educating these people on the harms of premature retraction.

Hang in there -- remember, stay calm but firm! You are not crazy, or anxious -- you are smart and educated.

[Quirky]

Here is a good paper for you to print off and take in to educate them, published in Emergency Medicine News:

http://journals.lww.com/em-news/Full...d_Penis.5.aspx

[Anastasiya]

It makes no sense to "need" to expose the entire head of the penis, as they did, to visualize and access only the urethral opening. If that was truly necessary then I would deem the nurse incompetent.

Does this hospital have a NICU? If so, call and talk to a nurse or two there and see if they can help you out. Boys are cathed ALL THE TIME without any retraction needed at all.

[MommytoB]

What area are you from ? That could lead to have someone to be more knowledgeable just like in montana they did give me the they have to touch but once I brought the papers to show if they did get any harm to my son's penis i have ability to sue .

So show them the way of how to insert a catheter in a intact baby by bring instructions.

[eepster]

Originally Posted by heartandhands

I am truly freaking out now. I asked the nurse but she said it's hospital policy.

I would bet my life saving that she was lying. If someone say something they want to do is "policy" that you believe is unnecessary, ask to see it. If it is policy, then it is in writing.

When DS needed to see a OT for problems with eating I was told that it was policy that they do a barium swallowing study (involved not just barium but also a lot of x-rays.) I made a phone call to my regular pediatrician and suddenly the policy disappeared.

Yelling "policy" is just another way to bully parents into being quiet.

Exactly what am I dealing with in terms of risks to my son's penis health?

Infection, pain, bleeding and paraphimosis are the main immediate concerns. Long term it can cause scarring and adhesions.

They said partial retraction would not be as sterile a technique and they needed it sterile to collect the urine.

Are they putting you through this just to get sterile urine sample?!

All that is necessary to get sterile urine from a baby is to clean the area thoroughly (does not involve retraction,) and tape a baggy to him and wait. This is just less convenient for the hospital.

Should I get him circ'd before this procedure is carried out? I mean assuming they refuse to alter their technique, is it better at this point to circ him and avoid damage??

With the exception of paraphimosis, all of the possible issues from forceful retraction are more likely to be caused by circumcision. Though paraphimosis, which is the worst thing that can happen from from forcible retraction, is not going to happen from being circ'd, the worst result of paraphimosis is that he will need a dorsal slit, which is done during a circ any way (so obviously not avoided.)

Then on top of the shared risks, there are all the other risks of circumcision. A boy has never died or lost his penis from forcible retraction, but many boys have died or lost a penis during a circ. No boy has ever developed meatal stenosis from forcible retraction, but 10% of circ'd boy develop it. There are many more risks from circ, but I won't go on since it is a long list. Though forcible retraction is not good and carries a few risks, circumcision is horrible and carries great risk.

A good comparison would be having his fingers cut off so that he never needs to worry about someone cutting his finger nails too short, or accidentally burning them on the stove.

All of this risk are that they will cause damage to the foreskin, obviously if the foreskin is removed it can't be further damaged, but then the very worst possible thing has already happened to it.

[an_aurora]

It is NOT policy for intact, non-retractile infants. The "policy" of cathing an intact adult male is to "gently retract foreskin", clean the meatus and glans, and insert the cath. This is not so for infants, who are not able to retract. Call BS on her and demand a nurse who is familiar with cathing intact infants (ie a Peds or NICU nurse, as suggested). There is no need to retract.